Germany’s Sick-Leave Costs Surge by €10 Billion as Coalition Pushes for First-Day Doctor’s Note
Published on 07/25/2026 at 09:02 | Redaktion boerse-global.de
The cost of employer-paid sick leave in Germany has jumped by €10 billion over three years, according to the Institute of the German Economy (IW), intensifying pressure on the ruling coalition to overhaul the country’s sick-pay rules. The figures come as new data from the DAK health insurance fund shows a slight dip in overall absenteeism during the first half of 2026.
DAK’s analysis, based on roughly 2.2 million insured workers, found that the sickness rate fell to 5.3 percent from 5.4 percent a year earlier. The average number of days off per insured person also edged down to 9.6 from 9.9. But the average duration of a single illness crept up to 9.7 days, compared with 9.5 days in the prior-year period.
Mental Health Now Tops the List
Despite the overall decline, the data reveals a significant shift in what’s keeping employees home. Mental health conditions became the leading cause of absenteeism, accounting for 184 sick days per 100 insured workers—a 9 percent jump. Respiratory illnesses, by contrast, dropped 21 percent to 175 days, while musculoskeletal disorders ranked third at 174 days.
Age played a notable role. Among workers under 55, sick-leave rates fell, but for those over 60, the rate rose by 0.3 percentage points.
Regional patterns varied widely. In Saxony-Anhalt, the sickness rate dropped from 6.6 percent to 6.3 percent, with respiratory-related absences falling 22 percent but mental health cases climbing 12 percent. Bremen saw a sharper decline from 5.7 percent to 5.1 percent, though mental illness remained the top cause even after a 19 percent reduction. Thuringia bucked the trend with a slight increase from 6.0 percent to 6.1 percent, where musculoskeletal issues were the primary driver. In that state, mental health conditions led to an average absence of 31.5 days.
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Coalition Eyes Mandatory Doctor’s Note on Day One
Against this backdrop, the black-red coalition is pushing forward with plans that would require employees to present a medical certificate starting from the first day of illness. The move would also eliminate the option of phone-based sick notes. Another proposal, floated by Economy Minister Katherina Reiche in autumn 2025, would reintroduce a so-called “waiting day”—meaning workers would forfeit pay for their first day of sickness.
DAK CEO Storm, along with state directors Kaiser, Meyrich, and Rühe, welcomed the government’s planned prevention initiative and the concept of partial sick leave—where employees can work reduced hours while recovering.
Pushback from Unions and Doctors
The proposals have drawn sharp criticism. Anja Piel of the German Trade Union Federation (DGB) warned they could overwhelm doctor’s offices and hurt productivity. Family physicians and health insurers have also voiced opposition, questioning whether the reforms would deliver real benefits.
Large corporations are taking a wait-and-see approach. BASF, the chemical giant, currently requires a doctor’s note only after the fourth day of illness. The company said it would assess any legal changes only after seeing a concrete draft bill. BASF’s works council chair, Sinischa Horvat, came out against tightening the existing rules.
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