Despite statistical effects: Merz questions telephone sick notes

Contents

Chancellor Friedrich Merz (CDU) has once again expressed doubts about telephone sick notes in light of the high rate of sick leave in Germany, according to dpa. During the election campaign for the state elections in Baden-Württemberg, Merz said that employees were averaging around 14.5 sick days per year. "That's almost three weeks in which people in Germany are not working due to illness. Is that really right? Is that really necessary?" he asked, announcing talks with coalition partner SPD. The telephone certificate of incapacity for work (AU) was sensible during the Corona pandemic, but needs to be reviewed today.

However, according to doctors, the debate ignores the context in which the regulation was introduced. The telephone AU was introduced in 2020 as an exception regulation due to the pandemic, subsequently extended several times with a deadline and re-evaluated each time. In December 2023, the Joint Federal Committee finally decided on a permanent regulation, but under clear conditions: patients must be known to the practice, and there must be no severe symptoms.

Doctors: Abolition does not prevent a sick day

The medical profession has already reacted critically to the political questioning in the past. The Association of General Practitioners described the telephone AU as one of the few successful measures to reduce bureaucracy in healthcare. Its abolition would place an additional burden on practices without reducing sick leave. Klaus Reinhardt, President of the German Medical Association, also saw no connection between telephone AU and increasing absenteeism in the past.

The telephone sick note does not change whether people are sick, only how they are treated. GP Marc Hanefeld comments on this: "If someone doesn't want to go to work and claims to have symptoms to me, I can almost never disprove it. How could I? That worked well with parents before when you didn't want to go to school."

The claim that the telephone AU is responsible for the increase in figures is therefore sharply rejected. "Anyone who claims that the telephone AU is 'to blame' for these figures is either an amateur or a liar. I consider both to be unacceptable for people in government responsibility," Hanefeld said.

eAU distorts the statistics

Doctors and health insurance companies primarily explain the increase in sick reports with the introduction of the electronic certificate of incapacity for work (eAU) at the beginning of 2022. Since then, all issued AUs are transmitted completely and automatically to the health insurance companies. Previously, many reports never reached them because insured persons did not submit the paper copy. Employers can then retrieve the proof from the communication server of the statutory health insurance funds – providing certain information such as the employee's name, date of birth, insurance number, and company number.

In addition, there is a structural problem: a "health certificate" still does not exist. If someone reports themselves fit for work earlier, this is only registered with the employer – but not with the health insurance company. In the statistics, only the issued AUs remain visible, not the actual days of absence.

According to calculations by DAK-Gesundheit, this pure reporting effect explains around 60 percent and more of the increase, depending on the diagnosis. Further factors include increased infection waves, particularly respiratory illnesses and Covid-19: Acute respiratory infections are treated and reported more frequently than before the pandemic (PDF). A cohort study published in the journal The Lancet Infectious Diseases shows that people have a significantly increased risk of further infections – particularly respiratory ones – in the year after recovering from a Covid-19 infection.

The Leibniz Centre for European Economic Research also concludes that the majority of the increase is due to better data collection and the obligation to use the electronic certificate of incapacity for work.

No indication of systematic abuse

Several studies also see no indication of systematic abuse of telephone sick notes. For example, dpa reported on an AOK study that saw no signs of abuse. DAK also found no increase in days of absence due to telephone AU. In the AOK study, three out of four employees rated the regulation as sensible, partly because it relieves doctors's practices and avoids infections in waiting rooms.

Paradoxically, doctors even report the opposite: because many employers now require a certificate on the first day of illness, patients seek practices even for mild infections. This leads to more doctor's contacts and more sick notes – an effect that further amplifies the statistical increase.

Political dispute continues

As dpa further reports, the Left Party and BSW accuse Merz of placing employees under general suspicion. BSW leader Fabio De Masi criticized that the problem is not the sick leave, but the "miserable economic policy." Furthermore, the coalition agreement between the CDU/CSU and the SPD does not provide for abolition, but only for adjustments to prevent abuse. Nevertheless, according to dpa, the CDU/CSU and employer associations continue to demand corrections – up to waiting days or restrictions on wage continuation. Doctors, however, warn against questioning a permanently established and evaluated regulation based on misunderstood figures – and thus putting further pressure on an already heavily burdened healthcare system.

(mack)