BKK analysis: Long-term illnesses, not colds, drive health insurance costs as government tightens sick note rules
A new analysis by Germany's company health insurance funds shows that long-term illnesses, not short colds, are the main cost driver for statutory health insurance, challenging the government's plan to require sick notes from day one.
Government plans to tighten sick note rules
The black-red coalition government has announced plans to require employees to submit a sick note from the first day of illness and to abolish the option of telephone sick notes. Chancellor Friedrich Merz (CDU) justified the measures as a way to reduce Germany's high sickness rate, which has sparked a heated debate.
BKK analysis: long-term illnesses drive costs
An analysis by the BKK Dachverband, which represents 63 company health insurance funds and around 9.6 million insured persons, now shows that short respiratory infections are not the main financial burden. Instead, long-term, often musculoskeletal and psychological conditions are the real cost drivers.
It is the long, often musculoskeletal and psychologically caused absences that become the actual cost driver.
Sickness benefit costs surge
Sickness benefit, paid only from the 43rd day of illness and thus affecting mainly those with prolonged conditions, has become one of the largest expenditure items for statutory health insurance at 21.6 billion euros. In 2025, more than a quarter of all absence days were due to sickness benefit claims. Over the past ten years, sickness benefit days have risen by 24.4 percent.
Psychological and musculoskeletal conditions dominate
Psychological illnesses account for only 5.4 percent of all sick notes, but their average duration exceeds five weeks and is rising. Together with musculoskeletal disorders, they are the main reasons for sickness benefit payments. The overall sickness rate remained stable at 6.1 percent in 2025, with respiratory illnesses being the most frequent cause of work incapacity but financially insignificant due to their short duration.
Call for prevention over restriction
Anne-Kathrin Klemm, board member of the BKK Dachverband, called for a serious debate on prevention strategies, particularly for psychological stress in the workplace.
We have been observing the trend of psychological strain in the working world for a long time. Otherwise we will continue to pay this bill for many years to come – and behind each one lies the long suffering of an affected person.
