Sickness rate in Germany: Development and influencing factors

While the Federal Statistical Office reports a further increase in 2023, the member-weighted sickness rate of employed AOK and BKK members indicates a slight decline. If the development is extrapolated with the trend of a non-representative BKK sample for 2024, the sickness rate will remain at an unchanged high level in 2024. However, the increase is smaller if effects resulting from the digital recording of certificates of incapacity for work from 2022 onwards are considered. But even then, the strong increase in 2022 remains striking.

A variety of hypotheses can be derived from the descriptive statistics of the umbrella organizations of the statutory health insurance funds AOK and BKK to explain the development of sickness rates - starting with socio-demographic characteristics such as age or gender, insured status or educational background, through to labour market-related characteristics such as professional activity, industry affiliation or company size. The explanatory contributions of different variables could be determined using a regression analysis approach. However, this requires access to anonymized insurance data, which has so far been denied for data protection reasons.

Several studies indicate a noticeable dampening of economic performance due to sickness absence. Irrespective of this, employers are directly burdened by rising expenses for continued remuneration during absence due to illness. This rise can only be partially explained by the increase in employment and nominal gross wages. Rising sickness rates also contribute to the burden. This motivates the reform debate on limiting the obligation to continue payment of wages during illness. Whether it is about periods without or with reduced wages or about limiting continued payment of wages to a maximum of six weeks per year, for example - the relief depends on not being slowed down by collective agreements.

In addition, there are indications that the certification of incapacity for work can be obtained in a legally dubious manner. This must also be prevented in view of demographic developments. Because in an ageing population it is becoming increasingly difficult and expensive for companies to maintain a sufficiently large ‘labour reserve’ to avoid revenue losses due to sickness absence. Even if the use of relevant internet portals to obtain a medical certificate for fee appears to be statistically insignificant so far, there are considerable doubts as to whether the issuance of certificate for fee is based on criteria comparable to those for personal consultation of a physician. This option should therefore be abolished. Further indications of legally doubtful handling arise related to medical certificates issued by telephone. An initial empirical study indicates that non-medical practice staff issue a considerable number of certificates without contacting a physician. If this unlawful practice is confirmed, rules must be found to ensure a medical consultation first.