Debate Over Phone Sick Notes and Sick Pay: BKK Sees Long-Term Illnesses as Cost Driver

Sick pay carries particular weight. It is only paid from the 43rd day of illness and therefore primarily affects people with prolonged illnesses. According to the BKK Dachverband, sick pay has meanwhile become one of the largest expenditure items of the GKV at 21.6 billion euros. „Es sind die langen, oft Muskel-Skelett und psychisch bedingten Ausfälle, die zum eigentlichen Kostentreiber werden", Klemm continued.

The share of sick pay days in all days of absence has grown significantly. „2025 entfielen demnach mehr als ein Viertel aller Fehltage auf den Bezug von Krankengeld", the analysis states. „Die Krankengeldtage seien in den vergangenen zehn Jahren um 24,4 Prozent gestiegen." The general level of sickness absence remained stable in 2025 at 6.1 percent.

The most common cause of inability to work remained respiratory illnesses – due to their short duration, they barely weighed on costs according to BKK. Against this backdrop, Klemm is calling for „eine ernsthafte Debatte über Präventionsstrategien". The psychological burden in the working world has long been observed: „Diese Rechnung zahlen wir sonst noch viele Jahre weiter – und hinter jeder steht das lange Leiden einer betroffenen Person."

Coalition Argues Over Phone Sick Notes

In parallel, the federal government is pushing ahead with its plans to reform sick notes. Federal Health Minister Nina Warken (CDU) is sticking to the abolition of the Telefon-AU. The black-red coalition had announced that it would move forward the requirement to submit a certificate of inability to work to the first day of illness and abolish the option of telephone sick notes. Federal Chancellor Friedrich Merz (CDU) justified the plans by saying the sickness rate was to be lowered.

One of the sharpest critics is Dr. Norbert Smetak, chairman of MEDIVERBUND, an independent, cross-specialty organization for office-based physicians and psychotherapists in Germany. He rejects the accusation that telephone sick notes are issued incorrectly: „Denn genau das wird ja unterstellt: Dass telefonische Krankschreibungen nicht korrekt erfolgen. Das weisen wir entschieden zurück." The Telefon-AU was introduced during the COVID-19 pandemic and has proven its worth.

Criticism from the Medical Profession

Smetak warns of the practical consequences of an abolition. „Allein der Umstand, dass die Praxen dann wieder überquellen von Patientinnen und Patienten, trägt dazu bei, Erreger zu verteilen." The bureaucratic burden is considerable, and he would instead have preferred waiting days as a steering instrument: „Ich wäre eher Anhänger von Karenztagen gewesen." The plans are also at odds with the federal government's digitization strategy. The option of a sick note after a video consultation is to be retained, however.

Smetak also points out that Germany has the highest number of sick notes in European comparison and asks whether this is due to low-threshold access or to working conditions. Scandinavian countries already use mandatory digital initial assessments for patients. The federal government is planning a primary care system with a digital initial assessment that decides whether a general practitioner or specialist appointment is needed, combined with a guaranteed appointment allocation.

SPD leader and Vice Chancellor Lars Klingbeil had partially walked back the plans on Sunday after fierce criticism. In an RTL interview he said it was about a compromise that now had to be shaped in a „vernünftig" way: „Niemand, der krank sei, solle am Ende wirklich zum Arzt gehen müssen." Federal Labor Minister Bärbel Bas announced that the regulations would be examined closely in the legislative process.

Outlook: Legislation and Shortage of Family Doctors

The black-red coalition is meanwhile planning further financial measures. After corrections from the ministry, around one billion euros from 2027 and around 2.75 billion euros permanently from 2031 are to be raised additionally. In addition, the state, according to contributions in the debate, owes money „etwa bei den versicherungsfremden Leistungen, wo eigentlich 12 Milliarden Euro zu leisten wären". Federal Chancellor Merz justified the plan with the goal of lowering the sickness rate.

The GKV Contribution Rate Stabilization Act is to be passed in the Bundestag by next Friday. This would see the black-red coalition take a further step toward financially stabilizing the healthcare system. Whether the abolition of the Telefon-AU will come in its original form remains open in view of the political debate.

The acute shortage of family doctors in Germany also remains in the background: fewer and fewer young physicians are taking over general practitioner or specialist practices. According to Smetak's assessment, the planned austerity measures will make setting up practice even less attractive – a risk for the already strained care situation. The question of from which day of illness employers may require a sick note also still lies solely in their discretion.