(de-news.net) – The FDP supports tax-free attendance incentives, while the SPD opposes the requirement for first-day sick notes, dividing Germany’s coalition. Medical leaders are cautioning about pressures related to access, staffing, and preventive care as the dispute develops alongside more general plans to reorganize primary care.
Wolfgang Kubicki, chairman of the FDP, has urged Germany’s governing coalition to abandon plans that would require workers to obtain a medical certificate from the first day of an illness. Instead, he favors allowing companies to provide tax-free bonuses to employees who have few sick days, presenting the approach as an incentive-based alternative to additional certification requirements.
Kubicki argues that the dispute over first-day sick notes reflects a broader tendency to address social and economic problems through increasingly extensive verification and documentation rules. In his assessment, such requirements risk producing greater administrative burdens, more bureaucracy, confusion and frustration without necessarily addressing the underlying issue. A monetary incentive, he contends, could encourage lower absenteeism while avoiding what he regards as excessive regulation of employees.
At the coalition’s most recent committee meeting, the CDU/CSU secured agreement on the first-day certification requirement. The proposal, however, has encountered opposition within the governing alliance, particularly from the Social Democratic Party. Bärbel Bas, the SPD chairwoman and labor minister, has questioned the measure’s usefulness and previously called on the Union to reconsider the contested provision through further talks.
Karl Lauterbach (SPD), a former health minister, has argued that the proposed change should not be introduced on its own but rather as part of a broader health-care package. According to media reports, he maintains that any additional burden created by earlier certification should be accompanied by improvements in access to care, particularly guaranteed medical appointments and preventive-health legislation. Lauterbach has also called for the package previously presented to the SPD parliamentary group to be implemented in full. He currently serves as chairman of the Bundestag’s Research Committee.
The disagreement over sick notes has unfolded alongside a broader debate about how patients should gain access to medical care and how the health system should manage demand. Klaus Reinhardt, president of the German Medical Association, has argued that patients who go directly to specialists rather than following a planned primary-care pathway could face disadvantages. Such consequences, he has suggested, would not necessarily involve financial penalties. Instead, patients who bypass the established referral structure could face longer waits than those who follow it, creating an incentive to use the system as intended.
The Federal Government plans to use new legislation to restructure primary care, although Health Minister Carsten Linnemann (CDU) has not yet presented a draft. Early reform proposals focus on stronger coordination of patient access and closer integration among different areas of care. Reinhardt argues that a more structured system could help address Germany’s notably high levels of doctor-patient interactions and hospital admissions, which he partly attributes to the country’s largely unrestricted access to medical services.
Under the proposed model, patients would generally consult their family physician first, with referrals to specialists provided when necessary. Outside regular office hours, the nationwide medical-service number 116117 could serve as the initial point of contact. Reinhardt has advocated a practical framework connecting family doctors, specialists and hospitals while limiting additional bureaucracy. Digital assessments and telemedicine, he says, could assist with initial triage and help direct patients toward the appropriate level of care.
Reinhardt calls for phone sick notes and broader workplace measures
At the same time, Reinhardt has warned that planned cost-cutting measures could place additional pressure on medical services. If funding for staff and open consultation hours is reduced, medical practices could find it more difficult to preserve sufficient appointment capacity. Doctors might consequently have to prioritize patients according to medical urgency. Among the areas potentially affected first could be administrative services that are not directly part of medical treatment, including assistance with applications for medical aids, long-term care services or disability benefits.
Reinhardt has expressed particular concern about possible reductions affecting preventive care and early-detection services. Such measures, he argues, could add another layer of pressure to a system already being asked to manage demand more selectively. His concerns therefore extend beyond the mechanics of sick-note certification to the broader question of how available medical resources are allocated.
If the coalition ultimately makes first-day certification mandatory, Reinhardt believes telephone sick notes should remain available for patients who are already known to a medical practice. He argues that retaining the option could keep people with minor infections from unnecessarily visiting doctors’ offices because telephone certificates currently account for only a very small share of all certified sick days. Video consultations could provide another option for established patients, although Reinhardt considers remote certification inappropriate for people who are entirely unfamiliar to the practice.
Despite supporting those alternatives, Reinhardt fundamentally rejects the idea that requiring certification from the first day would strengthen Germany’s work ethic. In his view, the frequency with which employees are absent because of illness is influenced more by conditions within workplaces than by the practices issuing medical certificates. Factors such as organizational culture, employee recognition, working conditions and opportunities for participation, he argues, can play a greater role in determining absenteeism.
If policymakers want to reduce sick leave, Reinhardt therefore believes they should look beyond stricter certification rules and consider broader workplace-related measures. Waiting or qualifying days could form part of that discussion, he has suggested. The debate consequently extends beyond whether workers should obtain a medical certificate on the first day of illness, encompassing competing views about incentives, regulation, access to care and the organization of Germany’s health system.
