- Observatory: EurWORK
- Health and well-being at work,
- Working conditions,
- Published on: 20 July 2010
Disclaimer: This information is made available as a service to the public but has not been edited or approved by the European Foundation for the Improvement of Living and Working Conditions. The content is the responsibility of the authors.
The German data on absence from work are not comparable to EU indicators, but instead are based on statistics provided by the statutory health insurers in medical ‘inability to work’ certificates. While there has been a considerable decline in absenteeism, several surveys reveal that presenteeism is a significant issue, particularly among small and medium-sized enterprises. Absence management seems to be increasing in importance at company level.
Definitions and aims of study
Absence from work is frequently discussed in terms of its costs. These costs were outlined in a report published by the European Foundation for the Improvement of Living and Working Conditions in 1997 – Preventing absenteeism at the workplace. Since that time – as many reports of the European Working Conditions Observatory (EWCO) and European Industrial Relations Observatory (EIRO) note – it has become an issue in many countries; one approach has been to try to reduce the costs by tightening rules on sick pay.
In addition to a focus on costs, sickness absence has been connected to wider debates on the quality of work in two main respects. Firstly, there is growing interest in well-being and health at work. Attention has thus turned to positive ways in which well-being can be promoted, with improved attendance being a possible consequence. Secondly, the concept of ‘presenteeism’ – meaning being present at work while feeling ill or being unable to work at normal capacity – has emerged. Presenteeism may mean that measured absence levels are low but also that there are hidden stresses and pressures on employees.
The purpose of this comparative study is to provide an overview of the extent of absence from work and policies for its management, and to place this overview in the context of wider debates on well-being and presenteeism. The report assesses the current picture in terms of the level of absence and how the problem is treated – purely in terms of cost or in relation to the quality of work. It also examines the effect of the economic recession on levels of absence and how the problem is viewed.
Absence is defined as non-attendance at work when attendance was scheduled or clearly expected. The specific focus is a period of absence lasting longer than three days; the comparative analysis seeks information on this level of absence but recognises that data may not always be available.
The study has two main themes: the extent and patterns of absence, together with any trends; and means of control and policies towards absence.
Extent and patterns of absence
1. Broad patterns
Where data are sought on the extent of absence, please use if possible the definition given in the briefing note. If available data do not distinguish between absence lasting longer than three days and all absences, please provide the closest available figure.
(a) Please describe the main data sources for absence from work at national level. How are the data collected and how is absence defined? Are the data broken down according to the length of absence? Which spells of absence are taken into consideration (e.g. three to 19 days and 20 days or more)?
There are no German data comparable with the indicators of the European Union or the World Health Organization (WHO). The basis of data on absence from work are medical ‘inability to work’ certificates, which doctors provide to health insurers within the first three days of illness. Under social law, the annual data on inability to work (Arbeitsunfähigkeit) of the Federal Ministry of Health (Bundesministerium für Gesundheit, BMG) are based on the statistics of the Statutory Health Insurance (Gesetzliche Krankenversicherung, GKV), which contains the data of all statutory health insurers. The data, published by BMG’s Federal Health Monitor, is based on a complete inventory count of all certificates of compulsory and voluntary members. In contrast, data on illness levels are based on the number of certificates of compulsory members at a scheduled day each month. The data do not differentiate between working day, weekend and holidays or between periods of absence.
The GKV data excludes:
all individuals insured with private insurers – such as civil servants or employees earning more than €4,050 a month who may choose between statutory and private insurers;
all individuals working in a marginal part-time job who are earning up to €400 a month (‘mini-job’) and who are not members of an insurer, but are insured through membership of a spouse or parent;
periods of occupational rehabilitation which are covered by organisations other than health insurers, such as by the German Pension Fund.
The second main data source on absenteeism is the annual report on health and safety at work (‘SUGA’), published by the Federal Ministry of Labour and Social Affairs (Bundesministerium für Arbeit und Soziales, BMAS) and the Federal Institute for Occupational Safety and Health (Bundesanstalt für Arbeitssicherheit und Arbeitsmedizin, BAUA). The BMAS/BAUA figures on ‘inability to work’ are derived from the inability to work certificates of all compulsory and voluntary members of merely five federal associations of statutory health insurers. These data include individuals insured through membership of a spouse or parent.
The two datasets find similar results in terms of days of inability to work per member or person insured. However, the results differ substantially with regard to the number of cases.
In addition, the Research Institute of AOK (Wissenschaftliches Instituts der AOK, WIdO) and the University of Bielefeld publish a yearbook on absence from work (Fehlzeiten-Report), which includes surveys and studies based on data of the health insurer AOK.
(b) Please state the average overall current level of absence either in terms of % of working time lost or number of working days a year. What has been the trend over the past five years?
There are no such data. Instead, the Institute for Employment Research (Institut für Arbeitsmarkt- und Berufsforschung, IAB) provides data (in German, 14Kb PDF) on the level of illness (based on BMG/GKV data) in terms of working days. According to the Federal Health Monitor, data on the illness level show similar tendencies as the level of inability to work. However, a July 2009 BMG press release warned that these data should not be confused with the level of absence. Also, Andersen, Grabka and Schwarze (2007) argue that data on illness do not correspond with the absence level. Surveys on absence from work for 2000, 2002 and 2004, based on socioeconomic panel data (SOEP, interviews of employees), show that the average number of days not worked did not change in that period – despite a declining illness level. The authors conclude that this is partially due to a growing number of cases of short-term sickness.
According to IAB data, the illness level of employees (members of statutory health insurers) decreased from an average of 7.7 working days a year in 2003 to 6.9 working days in 2007, rising again to 7.3 working days in 2008.
(c) Please provide a breakdown of absence by gender. What has been the trend over the past five years?
Days of inability to work among both genders decreased between 2003 and 2007 (Table 1). The number of cases dropped sharply from 2003 to 2004. Since then, the number of male cases has steadily declined, whereas the number of female cases showed a sudden increase in 2007. A study by Küsgens, Macco and Vetter (2008), based on AOK data, reveals differences in absence according to gender even if sector and occupation are considered. The authors suggest that differences in work-life balance might be a reason.
|Days of inability to work (IW days) per inability to work cases (IW cases)||13.77||13.92||13.35||13.01||12.50|
|IW days per 100 male GKV members||1,357.6||1,221.0||1,132.5||1,035.4||1,073.2|
|IW cases per 100 male GKV members||98.6||87.7||84.8||79.6||85.5|
|IW days per IW cases||13.26||13.34||12.85||12.64||12.35|
|IW days per 100 female GKV members||1,377.9||1,261.2||1,181.5||1,107.5||1,163.8|
|IW cases per 100 female GKV members||103.9||94.6||92.0||87.6||94.2|
|IW days per IW cases||13.53||13.64||13.11||12,83||12,43|
|IW days per 100 GKV members||1,366.8||1,239.2||1,154.8||1,068.3||1,114.6|
|IW cases per 100 GKV members||101.0||90.8||88.1||83.2||89.7|
Note: Table shows the level of absence by gender from 2003 to 2007 as measured by days of inability to work (IW days) and cases of inability to work (IW cases) per 100 compulsory and voluntary members of GKV.
Source: Federal Health Monitor, annual data on inability to work (Arbeitsunfähigkeit)
(d) Please provide a breakdown of absence by age groups (if possible, according to the following age groups: 15–29, 30–49 and 50 years). What has been the trend over the past five years?
As there are no data on age groups by BMG/GKV, this section refers to BAUA data (Table 2). Data show the strongest decrease in absence cases among young workers (15–25 years) and the lowest decline among workers aged 45–55 years.
|15–20 years||20–25 years||25–30 years||30–35 years||35–40 years||40–45 years||45–50 years||50–55 years||55–60 years||60–65 years||65 years|
Notes: Number of days are based on inability to work certificates; number of cases refer to cases per 100 members of the six federal associations of statutory health insurers.
Source: BAUA, 2009, p. 37
(e) Please provide any available estimates for the proportion of the total volume of absence a year due to short (3–19 days’ duration) spells and long-term absence (20 days or more). Have there been any changes in the prevalence of short-term and long-term levels of absence over the past five years?
No data are available
(f) Please give the level of absence in small and medium-sized enterprises (SMEs) with fewer than 250 employees, compared with large organisations.
(g) Please provide the latest figures on absence levels by sector of economic activity.
The health insurers provided the following data (Table 3) to BAUA (no further specification).
|Cases per 100 members||Days per cases|
|(A, B) Agriculture, forestry, fishing||98.2||13.0|
|(C, D, E) Mining, manufacturing industry excluding construction||140.2||11.9|
|(G, H, I) Wholesale and retail trade, hotels and restaurants, transport, storage and communication||116.1||12.2|
|(J, K) Financial intermediation, real estate and business activities||112.1||10.3|
|(L-Q) Public and private services||146.7||11.5|
|(A-Q) average and other||128.6||11.9|
Note: Table shows the level of absence from work by sector of economic activity. According to these findings (by cases and days of absence), the level of absence is highest in public and private services.
Source: BAUA, SUGA 2007, p. 96
2. Causes of absence
(a) Please describe the main causes of absence as identified in national surveys. Are there differences according to gender, company size or sector of economic activity?
According to Küsgens, Macco and Vetter (2008), the number of cases and days of absence due to diseases of the muscoskeletal system, the respiratory system and injuries/accidents (main causes) differ according to sector, occupation and gender.
(b) Please indicate the main occupational diseases and occupational injuries or accidents responsible for absence from work. Please identify and offer explanations for any changes that have occurred over the past five years.
|Days of inability to work, 2007 (% of all diseases)||Days of inability of work, 2003 (% of all diseases)|
|Mental and behavioural disorders||10.9||9.7|
|Diseases of circulatory system||6.1||6.3|
|Diseases of respiratory system||13.4||14.1|
|Diseases of digestive system||6.4||6.4|
|Diseases of muscoskeletal system and connective tissue||23.7||24.9|
|Injury, poisoning and other external causes||12.4||13.0|
|All other diseases||27.0||25.4|
Note: The table shows the diseases that cause the longest periods of absence from work in terms of days of inability to work, based on the International Classification of Diseases – 10th revision (ICD-10).
Source: BAUA, SUGA 2007, p. 28, Table 10
The data show a slight increase in mental disorders and a decrease in diseases of the muscoskeletal system and injuries by external causes.
Please refer to the definition of presenteeism: ‘being present at work while feeling ill or being unable to work at normal capacity’. What data are available on its extent?
For example, a Dutch study asked employees, ‘during the last 12 months, did it happen that you went to work, even when you thought you should report sick?’ Almost two thirds of respondents replied in the affirmative. Please report on any data available in surveys of working conditions, presenting the wording of the questions used.
According to a representative telephone-based survey by the Bertelsmann Foundation (Bertelsmann-Stiftung) – the Health Monitor – some 71% of employees went to work at least once during the last year although they felt ‘really sick’. Of these, 30% went to work even though the doctor advised staying at home.
In 2007, the research institute WIdO conducted a representative survey on presenteeism – based on telephone interviews with 2,000 statutory AOK members, who are aged 16–65 years and employed. According to the survey, nearly two thirds of all women and 59% of all men went to work despite feeling ill in the last year (Table 5).
Notes: Data show responses to the question: ‘During the last year, did it happen that you went to work, even though you really felt sick?’ Data on white-collar employees (non-executives) are not given.
Source: Zok, 2008
The Initiative Health and Work (Initiative Gesundheit und Arbeit, IGA) – a cooperation of three leading statutory health insurers and of the Statutory Accident Insurer (Deutsche Gesetzliche Unfallversicherung) – measured productivity loss due to presenteeism by applying the instrument known as the Work Productivity and Activity Impairment (WPAI) Questionnaire to the IGA-Barometer (in German, 908Kb PDF), a representative survey of 2,000 employees. According to the results, 27% of all employees felt sick at the moment they were surveyed. However, only 15% of these had been absent from work during the last seven days, whereas 59% said they felt a decline in productivity due to illness. Employees of SMEs were significantly more likely to go to work than employees of large companies. Employees in technical professions, healthcare and education voiced the strongest decline in productivity because of presenteeism.
|Absence from work||Productivity decline due to illness||Work Activity Impairment|
|Under 29 years||11||74||74|
|Teachers, social work||13||65||65|
Note: Table shows results of representative employee survey (IGA-Barometer 2007) based on WPAI methodology.
Source: Bödecker and Hüsing, 2008, p. 97
Costs and policies
4. Costs of absence
Are there estimates or studies on costs of absence from work? Please provide available information on:
(a) Figures for costs of absence from work for employers. Please summarise how the data are collected, how costs are compiled (what is included in the costs and concrete data) and measured (e.g. costs of absence as a percentage of company production or as a percentage of GDP for the whole country).
In the national debate on absence from work, the Federal Employers’ Association (Bundesvereinigung der Deutschen Arbeitgeberverbände, BDA) refers to BDA statistics on continued payment of remuneration (Entgeltfortzahlung). According to BDA, these costs amounted to €34 billion in 2008. However, this figure includes sick pay as well as payments in case of maternity leave, social security contributions and contributions to the health insurers.
In estimating the costs of absence, the federal institute BAUA relates the data of five statutory health insurers (see remarks above) to data on labour costs by the Federal Statistical Office (destatis).
|Estimated loss due to inability to work|
|Days and years of lost employment|
|35,317,000 employees x 12.4 days’ inability to work = 437.9 million days of inability to work = 1.2 million years of lost employment|
|Loss of productivity by labour costs|
|1.2 million lost years of employment x €33,500 average yearly wage = €40 million lost production due to inability to work = 1.6% of gross national income|
|Loss in gross value added|
|1.2 million lost years of employment x €60,900 average gross value added = €73 billion loss in gross value added = 3% of gross national income|
Note: Employees = compulsory and voluntary members of five statutory health insurers (without pensioners), not representative of all employees. Labour costs according to German National Account (Volkswirtschaftliche Gesamtrechnung) by destatis).
Source: BAUA, 2009, p. 27
(b) Figures for costs of absence from work for the social security system. Please summarise how the data are collected, how costs are compiled (what is included in the costs and concrete data) and measured (e.g. costs of absence as a percentage of social security expenditure).
There are no detailed data available. However, according to BMG figures (in German), in the period 1998 to 2007, the expenses of the Statutory Health Insurance Scheme with regard to individual sick pay decreased by 14.7%. Expenditure dropped from €7.05 billion to €6.02 billion and in 2008 accounted for 4.11% of the total costs of the Statutory Health Insurance Scheme. Sick pay is covered by health insurers after six weeks of sickness.
5. National and company measures
(a) Please outline any recent measures at national level intended to reduce the costs of absence through positive policies. An example would be changed social security rules on sick pay. Are any specific actions or measures directed at long-term absence?
The policies of BMG and BMAS are geared towards prevention. Under the Social Security Code IX (Sozialgesetzbuch IX, 2004), employers have to apply reintegration management practices (Betriebliches Eingliederungsmanagement) after six weeks of illness. These practices have to specifically target the well-being of a convalescent employee by transgressing typical measures of workplace health promotion. Health insurers may provide additional support to the employer if the reintegration management is settled by a works agreement and if the works council is involved in the implementation.
The 2009 Tax Act (Jahressteuergesetz 2009) grants employers a tax exemption of €500 and an exemption of social security contributions, with retroactive effect from 2008, for activities undertaken by the employer to improve the employees’ general health.
(b) What are companies doing to reduce overall absence from work (e.g. attendance incentives or bonuses)? Are sickness prevention plans elaborated? If so, how are elected employee representatives involved in these plans (e.g. through involvement in their design and implementation, or through being informed about them)? Please illustrate with up to three examples.
There are no data on the implementation of reintegration management practices. Company policies on sickness prevention cannot be generalised. According to the 2008 prevention report of the Central Federal Association of Health Insurance Funds (Spitzenverband Bund der Krankenkassen, GKV-Spitzenverband Bund) (DE0902019I), workplace health promotion is extensive but unevenly distributed across the sectors and strongest in the manufacturing industries.
Interviews after sick leave are a typical, but highly ambivalent instrument for collecting information on health risks and on individuals. Misuse has led trade unions to issue warnings not to reveal too much information and to involve the works council. In addition, the implementation of health and reintegration management systems may lead to extensive (health) data collecting (in German, 86Kb PDF) beyond rules of data protection. A legislative proposal (in German), issued on 4 September 2009 by BMAS, is directed against the unlawful, extensive collection of personnel (health) data.
(c) Do companies have any specific policies directed at long-term absence? What is done to encourage the reintegration into work of the long-term sick? Is work redesigned to meet the needs of employees?
Reintegration management may involve the redesigning of individual work tasks. Numerous websites of public authorities and health insurers promote health management at company level (Betriebliches Eingliederungsmanagement, BEM) or provide guidelines and good practice cases. For instance, the German Network on Occupational Safety and Health (Deutsches Netzwerk Betriebliche Gesundheitsförderung, DNBGF) presents the example (in German, 151Kb PDF) of the manufacturing company Carl Zeiss as a good practice case. The company cooperates with local hospitals and therapists in providing rapid support to employees; a works agreement arranges for the establishment of reintegration teams that take care of employees returning to the workplace.
6. Well-being at work
(a) Is the concept of well-being at work a feature of debates in your country? Which are the most relevant initiatives in this area, for example in relation to redesigning work to encourage attendance or to promote the health of employees? What are the objectives of such initiatives? How far do they aim to reduce absence levels, and is there any evidence of any reductions? Please provide up to three examples.
(b) To what extent do policies on the management of absence and on well-being engage elected employee representatives? At what stage are representatives involved?
(c) Please summarise the policy position of social partners, and if relevant other representative bodies, on the management of absence, attendance and well-being at work.
Prevention and ‘well-being at work’ are part of the focus of the Common German Occupational Safety Strategy (Gemeinsame Deutsche Arbeitsschutzstrategie, GDA) – as defined in 2008 by the National Occupational Safety Conference (Nationale Arbeitsschutzkonferenz, NKA) of the federal ministries of labour and of the interior, several regional states, the statutory accident insurers and the social partners. GDA’s 11 objectives focus on occupational health problems or on occupational safety and health (OSH) in certain jobs or sectors.
Under law, the works council is represented in the Health and Safety Committee, is involved in risk assessment, has to approve the selection of external and internal OSH experts and participates in inspection and monitoring activities on OSH. The works council may check the employers’ collection of personnel (health) data, participate in interviews after sick leave and has to approve reintegration management systems (works agreement). The trade unions provide blueprints (in German, 758Kb PDF) for respective agreements.
According to the employer organisation BDA, the decrease of absenteeism mirrors the structural change of employment and the employers’ high awareness of OSH. In contrast, the Confederation of German Trade Unions (Deutscher Gewerkschaftsbund, DGB) points to the economic crisis as a factor reinforcing the risks of presenteeism and of redundancies affecting those who are less healthy.
Please provide an assessment of national debates about absence. What is the balance between controlling high levels of absence, on the one hand, and promoting health and a positive work environment, on the other?
At national level, absenteeism is less of an issue today than it used to be a decade ago. Conversely, at company level, absence management is increasing in importance – in both a positive and a negative sense. From a positive perspective, the level of prevention is rising, although, as surveys show, certain groups at risk of absenteeism (such as employees of SMEs, women and employees with mental disorders) are insufficiently targeted by these measures. In a negative sense, absence management may be accompanied by an informal increase in the control of personnel data and by informal social selection in the event of redundancies.
Andersen, H., Grabka, M. and Schwarze, J., ‘Gesundheit’, in Federal Statistical Office (ed.), Datenreport 2006 (in German, 13Mb PDF), Zahlen und Fakten für die Bundesrepublik Deutschland, Auszug Teil II, Bonn, BPB, 2007, pp. 463–472.
Badura, B., Schröder, H. and Vetter, C. (eds.), Fehlzeiten-Report 2007. Arbeit, Geschlecht und Gesundheit, Heidelberg, Springer, 2008.
Badura, B., Schröder, H. and Vetter, C. (eds.), Fehlzeiten-Report 2008. Betriebliches Gesundheitsmanagement: Kosten und Nutzen, Heidelberg, Springer, 2009.
Bödecker, W. and Hüsing, T., IGA Report 12 (in German, 908Kb PDF), IGA-Barometer 2, IGA, 2008.
Bundesanstalt für Arbeitsschutz und Arbeitsmedizin (BAUA), Sicherheit und Gesundheit bei der Arbeit. Unfallverhütungsbericht 2007, Bundesministerium für Arbeit und Soziales (ed.), Dortmund, Berlin, Dresden, 2009.
Küsgens, I., Macco, K. and Vetter, C., ‘Krankheitsbedingte Fehlzeiten bei Frauen und Männern – Geschlechtsspezifische Unterschiede im Arbeitsunfähigkeitsverhalten’, in Badura, B. et al (eds.) Fehlzeiten-Report 2007, Heidelberg, Springer, 2008, pp. 97–119.
Medizinischer Dienst des Spitzenverbandes Bund der Krankenkassen, Präventionsbericht 2007, Düsseldorf, 2008.
Zok, K., ‘Krank zur Arbeit: Einstellungen und Verhalten von Frauen und Männern beim Umgang mit Krankheit am Arbeitsplatz’, in Badura, B. et al (eds.) Fehlzeiten-Report 2007, Heidelberg, Springer, 2008, pp. 121–144.
Birgit Kraemer, Institute of Economic and Social Research (WSI)