German Coalition’s Health Overhaul Targets Sick Notes but Misses Real Cost Driver, Critics Say
Veröffentlicht: 07.07.2026 um 15:45 Uhr, Redaktion boerse-global.de
When Germany’s coalition parties unveiled more than 60 amendments to the statutory health insurance (GKV) system on 6 July, the headline grabber was immediate: the telephone sick note is dead. Starting from the first day of illness, employees will need a doctor’s certificate—a shift that Chancellor Merz justified by pointing to the country’s high sickness absence rate. But beneath the political fanfare, independent analysts and medical associations argue the reform is aimed at the wrong target.
A fresh analysis by the BKK association of company health insurers, published on 7 July, undercuts the government’s rationale. Short, minor illnesses are not the main cost driver, the study finds. The real burden comes from long-term cases: sick pay kicks in only from the 43rd day of absence, yet those late-stage claims alone added up to €21.6 billion. Meanwhile, mental-health conditions represent just 5.4 percent of all sick-leave certifications but cause an average of more than five weeks of lost work. The overall sickness rate in Germany stood at a steady 6.1 percent in 2025.
Doctors’ associations reacted sharply. The German Association of General Practitioners called the move “symbolic politics,” noting that only between 0.8 and 1.2 percent of all sick notes were issued over the phone. Instead, it wants a crackdown on online platforms offering video consultations. The National Association of Statutory Health Insurance Physicians (KBV) projects at least 30 million extra practice visits a year, warning of crowded waiting rooms and increased infection risks. MEDIVERBUND and the KV Saxony echoed those concerns.
The reform package does include financial adjustments. The planned cuts to the federal subsidy for the GKV will be softened: instead of the originally envisioned €2 billion reduction, the subsidy will fall by €1.35 billion in 2027 and €1.55 billion in 2028. To partly plug the gap, the coalition has floated a new tax on sugar-sweetened beverages, expected to raise around €650 million in 2027 and €450 million annually thereafter. The federal contribution for treating basic-income recipients will also rise, reaching €2.75 billion by 2031, from €1 billion in 2027.
Yet despite these measures, an estimated €18.8 billion funding hole remains in the GKV system. Critics from the Greens’ parliamentary group complained about the process: the more than 60 amendment motions were submitted just before midnight on Sunday, leaving too little time for debate. Parliamentary secretary Irene Mihalic demanded a public discussion in the Bundestag.
Inside the coalition, even some members pushed back. The CDU’s worker wing (CDA) and SPD representatives called for a more pragmatic approach, proposing that companies should be able to decide by agreement whether to require a doctor’s note. The German Medical Association president, Dr. Klaus Reinhardt, stated on 7 July that the changes fell short of what is needed, calling for the full funding of non-insurance-related services by the federal budget. He added that the plans do nothing to improve outpatient care.
The legislative timeline is tight: debate in the health committee is set for 8 July, with Bundestag passage pencilled in for 9 or 10 July. The Bundesrat could cast its final vote on 10 July. Experts point out that part of the rise in recorded sick days since 2016 stems from the electronic sick-note system (eAU), which captures data far more comprehensively than before—meaning the apparent increase may not reflect a real jump in illness.
