Partial Sick Leave and Higher Co-Pays: Germany's Controversial Healthcare Reform Takes Shape

A looming multibillion-euro shortfall in Germany’s statutory health insurance system is driving the most sweeping changes in years — including a three-tier partial sick leave model from 2027 and a raft of cost-shifting measures that doctors and social advocates say will hit patients hard.

The government projects a financing gap of 15.3 billion euros in 2027, swelling to as much as 40 billion by 2030. In response, the reform package introduces what officials call a nuanced approach to incapacity: instead of a binary sick-or-healthy declaration, physicians will be able to certify a person as partially unfit for work at 25, 50, or 75 percent of their normal capacity.

That option, however, only kicks in after an employee has been ill for more than four weeks. A doctor must also issue a positive prognosis that the remaining work capacity can realistically be performed. The entire arrangement is voluntary, requiring the consent of the worker, the physician, and the employer. Unlike the existing “Hamburg Model” for gradual return, the new scheme ties more closely to sick-pay rules.

Once a doctor certifies partial incapacity, the employer has seven days to object. If no objection is filed, the workplace is deemed suitable for the reduced hours. Full wage continuation remains in place for the first six weeks of any illness. After that, a new partial sick pay — codified as Section 44d of the Social Code V — steps in, compensating the difference between part-time earnings and the previous net income. The 78-week cap for standard sick pay remains unaffected.

The rule applies solely to people covered by statutory health insurance. Privately insured individuals and mini-job holders are excluded.

Deficit-driven cuts across the board

The partial-incapacity scheme is just one element in a broader austerity push. Starting in 2027, prescription co-payments will rise to between €7.50 and €15, while other patient co-pays jump by roughly 50 percent. Homeopathic treatments and cannabis flowers will no longer be reimbursed. Subsidies for dental prostheses will drop by ten percentage points.

The contribution assessment ceiling — the income level up to which workers pay statutory insurance — will climb by €300 per month in 2027. From 2028, spouses covered through family insurance will face an extra premium surcharge of 2.5 percent.

Revenue increases for doctors and hospitals are also curbed. Between 2027 and 2029, clinic reimbursement will be capped at the base wage-growth rate minus one percentage point.

Medics and welfare groups sound alarms

The National Association of Statutory Health Insurance Physicians and the German Association of General Practitioners warn that the reforms will intensify budget constraints on outpatient care. Social welfare organizations VdK and SoVD argue the package creates a socially lopsided burden: chronically ill employees especially will feel the pinch from both higher out-of-pocket costs and the new partial sick leave.

Health Minister Warken defended the changes as essential to keep the system solvent. Opposition politicians countered that the plan places most of the weight on insured members and fails to tackle underlying structural inefficiencies.

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