Researchers have suggested that Germany’s plans to tighten the conditions for issuing sick leaves may be confusing a symptom – regular absence due to illness – with the disease itself, and have pointed to mental strain and worsening working conditions in sectors such as healthcare and education, Reuters writes.
Workers in Germany were absent for an average of 22 days due to illness in 2024, one of the highest rates worldwide. According to the BKK, the number of sick days rose sharply after the introduction of an electronic sick leave system in 2022, which facilitated the accurate recording of short-term absences.
German Chancellor Friedrich Merz’s plan provides for the abolition of sick days reported by phone, and a doctor’s certificate of illness will be required from the first day of absence. It is part of the government’s plan to boost productivity in an economy threatened by an ageing population and several years of weak growth.
However, researchers who study illness, mental health and the labour market are increasingly pointing to deeper problems in professions where sickness absence is highest, such as nursing, care homes and education. They point to factors that can lead to mental health problems in these professions – staff shortages, low pay, lack of career development opportunities and high emotional stress.
BKK data shows that in 2024,
women working in health and social care took an average of 27 days off due to sickness,
while teachers took an average of 24 days. In the financial and communications sectors, this number was significantly lower – 18 and 16 days respectively.
Johannes Siegrist, professor emeritus at the University of Düsseldorf, said it doesn’t have to be depression, but rather exhaustion and burnout caused by difficult working conditions.
Data from Germany’s largest health insurer, AOK, shows that mental health problems account for only 4.8% of sick leave, but when they do occur, an average of 28 days of absence are taken. At the same time, the number of sick days taken by AOK members related to mental health has increased by 47% since 2014, and is the second most common reason for absence after respiratory diseases.
People working in healthcare, education and social care are most likely to be diagnosed with mental health issues. Siegrist said that
these jobs involve a high level of responsibility, require a combination of performance and communication,
and often involve emotional problems; physical stressors, including violence, are also common. In addition, the pay for these jobs is low, and the professions have low socioeconomic status. The low wages, social status, and security in contrast to the high demands create what researchers call a work-reward imbalance.
A recent study of schools in Germany illustrates the problem. In 2024, the German School Barometer found that almost half of teachers reported experiencing psychological or physical violence among students, while more than a third felt emotionally exhausted several times a week. The situation is similar in healthcare. Despite acute staff shortages, wage increases have been surprisingly small, especially in hospitals and public health facilities. The German Health Ministry declined to comment on the high absenteeism rates in areas with the greatest mental and emotional pressure.
However, it is not the case that the high number of sick days among Germans can be explained solely by mental health problems. A range of factors, including demographics, workplace conditions, social norms and institutional differences, affect this, making international comparisons difficult.
Germany’s sickness benefit system is one of the most generous in the world
– the benefit replaces 100% of the salary from the first day of illness and is valid for up to six weeks. However, seven other OECD countries – Norway, Slovenia, Spain, Finland, France, Portugal and Belgium – report higher sick days among full-time workers. OECD researcher Sofia Malinai Domagk said that the rules on sick leave are just one factor, and the organisation would advise against making direct comparisons between countries.
Many institutions that have studied sick leave among German workers have not been able to find evidence of abuse of the system.
The government’s proposal to tighten the rules has also been criticised by the service providers’ union Verdi, which said it sets an example of a culture of distrust among workers. Medical associations have said it would be a disaster for an already overburdened healthcare system. The government has responded by saying that companies will be able to decide for themselves whether to follow the new rules, which also require a medical certificate from the fourth day of illness.
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