Germany’s Health Overhaul: Partial Sick Notes and Day-One Doctor’s Certificates

Germany is rewriting the rules of sick leave. Under a sweeping reform of the statutory health insurance system, doctors will no longer issue blanket unfit-for-work certificates. Instead, patients may be declared partially incapacitated — at levels of 25, 50, or 75 percent — in a bid to ease long-term absentees back into the workforce.

The DAK-Gesundheit insurer had pushed for such flexible arrangements ahead of the changes. The backdrop: Germany’s average sickness rate has dipped slightly to 9.6 lost days per insured person in the first half of 2026, down from 9.9 a year earlier. But the reasons behind those absences have shifted dramatically.

Mental health conditions now top the list for the first time, accounting for 184 sick days per 100 insured people — a nine percent jump. Respiratory illnesses, by contrast, have fallen 21 percent.

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Stricter rules from day one

Alongside the partial sick-note model, the government is tightening proof-of-illness requirements. Where previously a medical certificate was needed only from the fourth day of absence, it will now be mandatory from day one.

Phone-based sick notes are being scrapped entirely. Video consultations, however, remain a valid route to obtain a certificate.

Critics warn the changes will overload doctors’ practices. Surveys from June 2026 indicate that over 70 percent of employees already feel pressure to justify taking sick leave. Many respondents said they had worked while ill.

The stricter rules come with a condition inside the coalition government: they will only take effect alongside a guarantee of timely appointments with specialists, meant to shore up medical care.

Higher co-payments, lower subsidies

The reform reaches deep into patients’ wallets:

• Medication: Co-payments rise to between €7.50 and €15
• Dental prosthetics: The statutory subsidy drops to 50 percent
• Homeopathy: Struck from the list of covered treatments
• Contribution ceiling: Rises by €300 per month in 2027
• Family insurance: From 2028, certain co-insured spouses will pay a 2.5 percent surcharge

To keep supplementary premiums stable, the government has capped fee increases for doctors. In Saxony, regional associations of statutory health insurance physicians already anticipate lower fees — a development that could squeeze primary care in rural areas.

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Digital push to ease the burden

A second relief cabinet meeting in July 2026 introduced additional measures. The Health Digitalisation Act (GeDIG) promotes cloud technologies in hospitals and standardises electronic referrals.

The Federal Employment Agency is accelerating its own digital transformation. Other deregulation moves: electric cars will no longer require environmental badges, and taxi drivers will no longer need a specialist knowledge certificate. A comprehensive bill to cut bureaucratic reporting is planned for the turn of 2026/2027.

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