Health insurance companies: Long outages are the biggest cost drivers

Health insurance companies

Sick notes: The biggest cost driver is not colds

The black-red coalition wants to make sick leave more difficult. But data from company health insurance companies suggests that the measures ignore the actual cost driver.

An analysis of sick leave by the BKK umbrella organization of company health insurance companies has shown that it is not short colds, but rather long, serious illnesses that are the major cost drivers for statutory health insurance. “It is the long, often musculoskeletal and psychologically-related failures that become the real cost drivers,” said Anne-Kathrin Klemm, board member of the BKK umbrella organization.

Sickness benefit – which is only paid from the 43rd day of illness and therefore primarily affects people with long-term illnesses – is now one of the largest expenditure items in statutory health insurance at 21.6 billion euros, according to the BKK. In 2025, more than a quarter of all days of absence were due to receiving sick pay. Days of sick pay have increased by 24.4 percent over the past ten years.

The main drivers are mental illnesses and musculoskeletal disorders. Although mental illnesses only accounted for 5.4 percent of all sick notes, they lasted on average for more than five weeks – and the trend is increasing. Klemm is therefore calling for a serious debate about prevention strategies: “We have been observing the trend of psychological stress in the world of work for a long time. Otherwise we will continue to pay this bill for many years to come – and behind each one there is the long suffering of an affected person.”

The Sick leave Overall, 2025 remained stable at 6.1 percent. The most common cause of incapacity to work was respiratory illnesses, which, according to the BKK, are of little financial significance because of their short duration.

The black-red coalition announced a few days ago that it wanted to bring forward the obligation to present a certificate of incapacity for work to the first day of illness and to abolish the possibility of taking sick leave over the telephone. Chancellor Friedrich Merz (CDU) justified the plans by saying that sick leave should be reduced.