Mental Health and Back Pain Push Germany’s Sick-Pay Bill to a Record €21.6 Billion

6 billion in sick pay (Krankengeld) in 2025 — an all-time high. The surge is not driven by common colds but by long-term illnesses that keep people off work for weeks. Mental health disorders and musculoskeletal conditions, such as chronic back pain, account for the bulk of lost working days.

The overall sickness rate hit 6.1 percent last year, averaging 22.1 days absent per employee. Of those, 6.8 days fell under sick pay, which kicks in after an employer’s six-week wage-continuation period ends. Within a decade, the number of sick-pay days per insured person has climbed 24.4 percent.

As long-term absences continue to rise, proactive workplace health management becomes essential. A free Health & Safety at Work Act 1974 Toolkit gives UK employers nine ready-to-use tools including risk assessments, compliance checklists, and director liability guidance to help protect your workforce and avoid costly penalties. Download the free Health & Safety at Work Act 1974 Toolkit

Regional Gap of 10.5 Days

Geographic differences are stark. Employees in Baden-Württemberg missed 18.5 days on average, while those in Mecklenburg-Vorpommern were absent 29.0 days — a gap of 10.5 days. Across all regions, a single mental-health episode lasts a mean 39.1 days, making it the second most common cause of long absences. Those cases accounted for 2.2 sick-pay days per insured person. Musculoskeletal problems followed closely, at 1.7 days per person.

Prevention Spending Tops €218 Million

Health insurers invested €218.4 million in prevention courses in 2025, funding roughly 1.9 million participants. Certified preventive health trips, with subsidies ranging from €75 to €200, are part of the mix. Health economists view such offers as a way to curb long-term absences.

Some employers are setting examples. The Marburg-Biedenkopf county administration received its third award in 2026 for workplace health management. In partnership with AOK Hessen, it offers spinal screenings, back-health lectures, and running sessions.

Following the example of employers investing in workplace health, UK companies can strengthen their own safety practices with a comprehensive Health & Safety Toolkit. Used by over 37,000 British businesses, it covers everything from risk assessments and COSHH to fire safety and first aid. Download the free Health & Safety Toolkit

Support for Small Firms and Growing Private Options

German law requires employers to run an occupational reintegration programme (BEM) once a worker has been absent more than 42 days in a twelve-month period. Small and mid-sized companies often struggle to comply. At a specialist conference in late June 2026, the federally funded “fit2work” programme was presented. Backed by the Federal Ministry of Labour and Social Affairs, it provides free advice on heat protection, return-to-work after long sick leaves, and psychosocial hazard assessments.

Meanwhile, company health insurance plans (bKV) are gaining traction. They give employees faster access to psychological counselling or coaching — a response to waiting times of six to twelve months for therapy slots in the public system.

Union Caution on Stricter Proof Rules

Worker representatives warn against policies that put ill employees under blanket suspicion. Rather than tightening the requirement to present a doctor’s note from the first day of sickness, they argue, the focus should be on preventing long-term cases through better workplace ergonomics and effective stress management.

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