DIW economist warns: Tightened sick note rules could increase absenteeism

A requirement to obtain a sick note from the first day of illness could instead lead to more visits to doctor' offices and increase the risk of infection in waiting rooms. If this were to cause people to go to work despite mild infections, infections in the workplace could ultimately lead to more days of absence than if those employees had simply stayed home.

Graeber cites other, more important factors for the high sickness rates: more important are other factors such as the more complete recording of sick notes since the introduction of the electronic sick note (eAU), strong waves of infections, and longer-lasting illnesses. In 2024, for example, long-term illnesses of more than six weeks accounted for around 40 percent of all days of absence, even though they made up only a small share of sick notes. These often involve musculoskeletal and mental illnesses. Health prevention would help more here, according to Graeber.

Chancellor Friedrich Merz had defended the tightening with the reasoning that the number of sick days in Germany is too high. One cannot accept "exorbitant" sickness rates. On Maybrit Illner, Merz pointed out that the government is returning to a rule that was already in place before the pandemic.

Survey: Majority of the population rejects both plans

A representative YouGov survey of 6,200 adults in Germany shows, however, a clear rejection of both plans. According to the survey, 59 percent of respondents are against a requirement to submit a sick note from the first day of illness, while 31 percent support it. The planned abolition of the telephone sick note for milder illnesses is rejected by 58 percent, while 33 percent support it.

Criticism is also coming from the German Trade Union Confederation (DGB). DGB board member Anja Piel warned in the newspapers of the Funke Media Group that the requirement to obtain a sick note from day one could encourage presenteeism — that is, working despite being ill. Presenteeism has negative consequences such as falling productivity and more chronic illnesses. The combination of a day-one sick note requirement and the abolition of telephone sick notes also leads "directly to the overload of all doctor's offices in the country," said Piel.

Criticism from DGB and family doctors

The family doctors also disagree. Nicola Buhlinger-Göpfarth, federal chair of the German Association of Family Doctors, called the planned changes "pure symbolic politics." They would neither reduce sickness rates nor prevent abuse. Telephone sick notes do not offer any greater potential for abuse than a visit to a doctor's office, since the practice needs to know the patient. "If there is a big potential for abuse anywhere, then it is with anonymous platforms that profit from it and don't even know their customers. There, fraud is wide open, and not in our practices."

For context: according to DIW, the share of sick notes issued by phone or video among all incapacity-to-work certificates is around 0.8 to 1.2 percent. In addition, many employment and collective bargaining agreements contain deviating provisions, so the sick note requirement would only kick in later depending on the contract.

The debate comes amid a phase of rising strain on the healthcare system. Graeber emphasizes that prevention is the most effective tool against the dominant long-term illnesses. Buhlinger-Göpfarth instead calls for limiting the spread of aggressively advertising video consultation providers in order to effectively combat abuse.

It remains to be seen how the coalition will concretely shape the regulations in the parliamentary process. Both measures — the day-one sick note requirement and the end of the telephone sick note — still need to be put into legislative form. Employer, physician, and union representatives have already signaled clear resistance.