High levels of sickness are currently causing discussions again. In the CDU and CSU, telephone sick leave is once again blamed for this. The employers’ associations also agree. The reason for this is the high level of sickness. In Hesse it remained stable in 2025 compared to the previous year, although at a high level.
According to an evaluation by the DAK of those insured by it, the employees were on sick leave for an average of 20.4 calendar days and therefore had the same amount of lost work as in the previous year. According to DAK information, most days of absence were due to respiratory illnesses, followed by mental illnesses. These caused ten percent more days of absence than in 2024. Musculoskeletal diseases came in third place.
Absenteeism in Hesse is significantly higher than at the national level. DAK-insured employees had a national average of 16.6 days of absence due to illness in 2025. With more than 20 days, Hesse is 4.5 percent above the national average. Absences were significantly higher in Saxony-Anhalt as well as in Mecklenburg-Western Pomerania and Brandenburg. Baden-Württemberg had the lowest loss of work nationwide. For the current analysis, the Berlin IGES Institute evaluated the data from around 257,000 employed DAK insured people in Hesse.
High costs for employers
In view of the numbers, the Hessian business associations (VhU) say: “Telephone sick leave should be abolished as quickly as possible because it lowers the hurdles for ‘blue-collaring’.” According to VhU estimates, the costs to employers for continued payment of wages in the event of illness amount to more than six billion euros per year across Hesse. However, VhU managing director Dirk Pollert also told the German Press Agency: “Fortunately, abuse of sick leave is not the rule, but it does exist and it should be stopped.”
The DAK cannot clarify to what extent telephone sick leave plays a role. “In the process of transmitting sick notes to the health insurance companies, no information is provided about whether a sick note was issued by telephone or during a visit to the practice,” says the DAK Hessen in response to a FAZ query. Therefore, there are no statistics about what proportion of sick notifications were caused by telephone sick notifications.
“The possibility of a sick note by telephone is fundamentally correct, as it relieves pressure on doctors’ practices and patients, especially during flu and cold waves. General practitioners also confirm this,” says DAK regional director Britta Dalhoff. The statistics do not show a significant increase in sick leave due to this instrument. “However, abuse by ‘fake’ doctors and online platforms must be prevented,” she adds. She also points out that, parallel to the introduction of telephone sick leave in May 2020, the DAK examined whether there were changes in sick leave due to minor respiratory illnesses. The result: There was no change in the number of corresponding sick notes.
Basically, according to Dalhoff’s presentation, the health insurance company’s data shows that the electronic certificate of incapacity for work (eAU) is an important driver for the increase in sick leave. Since the beginning of 2022 at the latest, sick notes have been sent directly from the doctor’s office to the health insurance companies and no longer have to be submitted by the insured persons themselves. Therefore, they were no longer lost so easily. The consequence of the new electronic reporting procedure is a statistical effect with a sharp increase since 2022, says Dalhoff. “But before we discuss individual measures, we should specifically analyze and evaluate the causes of the persistently high sickness rate in Hesse,” she demands.
With around 431 days of absence per 100 insured people after 434 days of absence in 2024, respiratory diseases make up the largest proportion of sick notes. Mental illnesses were in second place with 383 days of absence per 100 insured people, significantly more than in the previous year (348 days of absence). This was followed by musculoskeletal problems such as back pain, which remained roughly stable at 348 days per 100 insured people compared to 2024.
“It is now necessary to carry out well-founded research into the causes and develop new solutions,” says Britta Dalhoff, commenting on the results, which mean that sickness levels are leveling off at a high level. To achieve this, all relevant actors – employers, unions, doctors and health insurance companies – must work together, she demands. Dalhoff sees corporate health management as an important component. “Good working conditions and a strong corporate culture are key levers for reducing sickness rates,” said the DAK state manager.
