Analysis-Germany’s sick-note crackdown may be treating the symptoms, not the disease

By Francesco Canepa and Maria Martinez

FRANKFURT, July 27 (Reuters) – Germany’s plans to tighten sickness absence rules may be mistaking signs of increased absenteeism for underlying illness, researchers say, citing mental health problems and worsening working conditions in sectors such as healthcare and education.

Workers in Germany took an average of 22 days of sick leave in ‌2024; this is one of the highest levels internationally. This figure, from company health insurers association BKK, rose sharply in 2022 with the introduction of electronic sickness note reporting, which improves the recording of short-term absences.

Under plans adopted by Chancellor Friedrich Merz’s coalition, telephone sick notes would be scrapped and employers would be able to request medical certification from the first day of absence, as part of a broader effort to boost productivity in an economy grappling with an aging population and years of weak growth.

But researchers studying illness, mental health and labor markets increasingly point to deeper problems in professions with high absenteeism, such as nursing, care work and teaching.

They cite chronic understaffing, low pay, poor career prospects, and high emotional demands as risk factors for poor mental health in these professions.

According to BKK data, in 2024, the last year for which sectoral data is available, women in the health and social services sector took an average of 27 days of sick leave, while teachers spent 24 days; On the other hand, 18 days were seen in the field of finance and 16 days in the field of communication.

“This doesn’t need to be full-blown depression,” said Johannes Siegrist, professor emeritus at the University of Duesseldorf. “It may also be a state of exhaustion or burnout as a result of problematic working conditions.”

Mental disorders account for only 4.8% of illness cases, but when they occur, they cause an average of 28 days of absence, according to data from AOK, Germany’s largest health insurance provider.

The number of sick leave days taken by AOK members for mental health issues has increased by 47% since 2014, making it the second biggest cause of absence after respiratory illness.

HIGH RESPONSIBILITY, LOW REWARD

Health, education and social services tend to have the highest rate of mental health-related diagnoses.

“They have high-responsibility jobs, they need to combine task performance and social interaction, and they need to deal with emotional issues as well as physical stressors, including violence,” Siegrist said. “And often these are low-wage people with pretty low socioeconomic status.”

The combination of low pay, social status, or security with high demands is what scholars describe as effort-reward imbalance.

Numerous international occupational health studies have linked this imbalance to mental health problems and long-term absenteeism. It also increases the risk of coronary heart disease.

Recent evidence from schools in Germany shows the problem. The 2024 German School Barometer found that almost half of teachers reported psychological or physical violence among students in their school, while more than a third felt emotionally drained several times a week.

Nursing tells a similar story. Despite acute staff shortages, recent research in Germany has found surprisingly limited wage increases, especially in hospitals and public institutions.

The health ministry declined to comment when asked why absenteeism rates were highest in sectors where mental health and emotional pressures are highest.

NO SIGNS OF COMMON ABUSE

None of this means that Germany’s absenteeism problem can be explained by mental health alone.

Sickness absence is affected by a number of factors such as demographic characteristics, workplace conditions, social norms and institutional differences, making international comparisons difficult.

Germany’s sick pay regulations, which cover 100% of wages for up to six weeks from the first day of illness, are some of the most generous in the world.

However, seven OECD countries (Norway, Slovenia, Spain, Finland, France, Portugal and Belgium) report higher incidences of sick leave among full-time workers.

“We can say that sick leave rules are one of many factors, and we should be careful not to look too closely at direct country comparisons of sick leave rates,” OECD researcher Sofia Malinai Domagk said.

Most institutions examining the increase in absenteeism in Germany have struggled to find evidence of widespread abuses.

A study by health insurer DAK and the IGES institute found that the sharp increase in absences recorded in 2022 was largely due to better electronic reporting and unusually strong waves of respiratory diseases and COVID infections. Since then, the number of sick days has stabilized.

The study found no evidence that telephone sickness notifications, introduced during the pandemic in 2020, were responsible for this increase, and concluded that neither telephone certification nor routine malingering could explain the record levels of illness.

“Current scientific studies show that telephone sick leave does not lead to an increase in sick leave reports,” said Enzo Weber of the Employment Research Institute.

BEYOND BEING A POLICE

The government’s proposal was also criticized by services union Verdi, which said it was an example of a “culture of distrust” towards workers.

Doctors’ associations said this would be “absolutely catastrophic” for already overburdened medical practices.

In response, the government said companies will have the freedom to decide whether they want to comply with the new rule or continue the obligation to provide a medical certificate from the fourth day of the illness.

(Reporting by Francesco Canepa and Maria Martinez; Editing by Hugh Lawson)