German Sickness Crisis Deepens: Mental Ill-Health Overtakes Back Pain as €19 Billion Hole Looms

Two out of three employees in Germany have gone to work while ill, a phenomenon known as presenteeism that is particularly rife in healthcare and nursing, where 77% of staff report turning up sick. The trend is most pronounced among Generation Z, with roughly 65% admitting they worked despite being unwell. The main drivers, according to the AK Salzburg labour climate index, are a lack of replacement staff, solidarity with colleagues, and mounting performance pressure.

At the same time, mental illness has for the first time displaced musculoskeletal disorders as the leading cause of sick leave. Data from DAK-Gesundheit for 2025 shows a stable sickness rate of 5.4%, with insured employees missing an average of 19.5 calendar days. Psychological conditions jumped 6.9% to 366 absence days per 100 insured members, pushing back pain and joint problems from the top spot.

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The dual burden of presenteeism and rising mental-health absences is now fuelling a financial crisis in Germany’s statutory health insurance system (GKV). In the first quarter of 2026, expenditure surged 7.6–7.7%, while contribution income rose only 4.1%. Although the GKV posted a surplus of €1.3 billion, that money went straight into reserves, which at €6.18 billion barely meet the legal minimum.

Health Minister Warken has warned that without corrective action the system faces a financing gap of €19 billion in 2027. To prevent contribution rates from rising sharply, an additional €2.5 billion in federal funds would be needed. The biggest cost drivers are hospital treatment (up 9.3%), plus higher spending on prescription drugs and doctors’ fees.

In a related legal challenge, 79 individual health funds have filed a joint lawsuit against the federal government. They argue that the flat-rate government payments for recipients of Bürgergeld (the basic income benefit) do not cover actual medical costs. The insurers are demanding that these so-called non-insurance benefits be financed from tax revenues instead.

Political reactions to the crisis are sharply divided. DAK chief Andreas Storm has called for a national summit on sick leave at the Chancellor’s Office, with cross-sector measures to tackle the root causes. He floated the idea of a partial sick note that would allow employees with less severe conditions to work reduced hours. Chancellor Friedrich Merz has questioned the continued use of telephone sick notes, citing the huge economic cost of absenteeism.

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KBV (National Association of Statutory Health Insurance Physicians) head Andreas Gassen suggests abolishing the requirement for a doctor’s note for the first three days of illness. TK (Techniker Krankenkasse) CEO Jens Baas disagrees, insisting the focus must be on serious psychological disorders and chronic back problems – not on minor ailments.

Regional disparities in sick leave remain enormous. In Saxony-Anhalt, insured workers missed an average of 28.4 days in 2024, compared with just 17.5 days in Mainz. Data from Barmer for Rhineland-Palatinate puts the 2025 average at 22.5 days. Across all sectors, healthcare recorded the highest absence rate at 6.2%, while data processing had the lowest at 3.4%.

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