Germany's Plan to Tighten Sick Leave Rules Faces Questions Over Root Causes of Absenteeism

Germany's proposal to tighten sick leave rules is drawing concern from researchers who argue that the government may be focusing on attendance policies instead of the workplace conditions contributing to employee absences.

According to BKK, an association of company health insurers, employees in Germany recorded an average of about 22 sick days in 2024. The figure rose significantly after electronic sick-note reporting was introduced in 2022, which improved the tracking of short-term absences.

Under measures agreed by Chancellor Friedrich Merz's coalition government, telephone-based sick notes would be removed, and employers would have the option to request a medical certificate from the first day of an employee's illness. The changes are part of broader efforts to improve productivity as Germany faces weak economic growth and an ageing workforce.

Researchers studying labour markets and occupational health say that sectors with the highest absenteeism—such as healthcare, education, and social care—also face long-standing challenges including staff shortages, lower pay, demanding workloads, and limited career opportunities.

BKK data for 2024 shows that women working in healthcare and social services averaged 27 sick days, while teachers averaged 24 days. By comparison, workers in finance averaged 18 days and those in the communications sector averaged 16.

Johannes Siegrist, emeritus professor at the University of Duesseldorf, said prolonged exhaustion and burnout linked to difficult working conditions can contribute to sickness absence, even when employees are not experiencing severe depression.

Data from Germany's largest health insurer, AOK, shows that mental health conditions account for 4.8% of sickness cases but lead to an average absence of 28 days. Since 2014, the number of sick leave days linked to mental health among AOK members has increased by 47%, making it the second-largest cause of absence after respiratory illnesses.

Researchers also point to the combination of demanding responsibilities and relatively low pay in healthcare, education, and social services as a factor affecting employee wellbeing. Occupational health studies have associated this imbalance between effort and reward with higher risks of mental health issues, extended absences, and cardiovascular disease.

Recent findings from Germany's 2024 School Barometer reported that nearly half of teachers experienced psychological or physical violence among students at their schools, while more than one-third said they felt emotionally exhausted several times each week. Studies on nursing have also found that wage growth has remained limited despite persistent staffing shortages, particularly in hospitals and public institutions.

The German health ministry declined to comment on whether the sectors with the highest absenteeism are also those facing the greatest emotional and mental health pressures.

Researchers note that sick leave is influenced by several factors, including demographics, workplace conditions, social norms, and national policies, making direct international comparisons difficult. Germany provides full wage replacement for up to six weeks of illness, but OECD data shows that seven member countries report even higher rates of sick leave among full-time workers.

An OECD researcher said sick leave policies are only one of many factors affecting absence rates and cautioned against drawing simple comparisons between countries.

Studies by health insurer DAK and research institute IGES concluded that the increase in recorded absences in 2022 was largely linked to electronic reporting improvements along with high levels of respiratory illnesses and COVID-19 infections. The research found no evidence that telephone sick notes or widespread misuse of the system caused the increase, and sickness levels have since stabilized.

Enzo Weber of the Institute of Employment Research also said available research does not indicate that telephone certification led to higher numbers of sick leave reports.

The government's proposal has faced criticism from the Verdi services union, which described it as reflecting a lack of trust in employees. Medical associations also warned that requiring more in-person certifications could place additional pressure on already busy healthcare practices.

The government said employers will be free to decide whether to require medical certificates from the first day of illness or continue using the current practice of requesting them from the fourth day.