Where Germany stands today
Germany is experiencing historically high levels of absenteeism. In 2023, the average days of incapacity for work (AU days) per employee were 21.0; The Federal Institute for Occupational Safety and Health (BAuA) estimates a €128 billion loss in production and a €221 billion loss in gross value added. The level is driven by pronounced cold waves and a high number of cases.
The sickness absence rates vary depending on the fund and collective: TK reports sickness absence of 5.23% in 2024 (2023: 5.31%), AOK for 2023 6.6%. This range is an initial signal of the “data gap”: differences in population, definitions and measurement methods distort benchmarks and the investment decisions derived from them.
At the same time, the diagnostic mix is shifting: musculoskeletal (19.5%) and respiratory (15.4%) continue to dominate, but mental illnesses account for 11.9% of AU days – and AU days due to mental illness have increased by almost 47% since 2014. On average, a psychological case lasts a long time (AOK 2023: Ø 28.1 calendar days per case; DAK 2024 reports Ø 32.9 days), which increases the return and productivity effects.
New Work Paradox & Presence Culture
Flexible working does not automatically reduce absenteeism. Initial findings show, on the contrary, that working from home can promote virtual presenteeism and thus lengthen recovery times and promote subsequent AU. Recent studies for Germany show higher tendencies towards presenteeism in remote settings. Of course, presenteeism also exists equally in traditional office workplace and production workplace settings. In representative TK/IFBG analyses, around one in two people stated that they worked sick at least sometimes; more than a quarter even frequently.
Presenteeism is a key, often underestimated driver of the loss of productivity – international reviews show that its effects at least reach the extent of absenteeism and in some cases exceed it. For management in companies, this means not only managing absences, but also making sick work visible and reducing it.
Leadership like Hebel
Leadership and fairness have a measurable effect: high organizational justice and a trust-based leadership culture correlate in long-term studies with fewer and shorter absences; low fairness is associated with increased risk of AU. This connection makes leadership the centerpiece: good leadership dampens presenteeism triggers and stabilizes return processes.
On the left we summarize the pain drivers (record costs, cultural erosion due to unregulated flex work, ESG risk due to long-term psychological problems). On the right are the gains of an integrated program (productivity ↑, employer attractiveness ↑, resilience ↑).
The central axis marks “leadership” as the main lever that addresses both absence and presenteeism.
Frühzeitiges BEM & Return-to-Work
Early, structured BEM (including pre-BEM) improves the chances of a quick, sustainable return and reduces the risk of recurrence. The effect depends on process quality, speed and the involvement of management, company doctors and rehabilitation providers.
The business case is robust
Meta reviews by the Health & Work Initiative (iga) show consistently positive returns for integrated WHM programs over two decades: ROI range ~ 1: 2.3 to 1: 5.9, depending on the approach and implementation. Updates confirm the effectiveness, but call for methodical care when calculating ROI (e.g. clear KPI definition, separation of absenteeism/presenteeism, implementation times). Newer models calculate the Value on Investment (VoI) and thus determine the value contributions of healthy work in driver and effect chains individually for organizations. The developments for calculating value contributions appear to be more effective and promising for control and budgeting.
The illustrative calculation for 5,000 employees (average cost day €380) shows the Euro impact of typical target corridors:
- AU-Quote von z. B. 5,5 % → 4,5 %,
- Ø case duration of ~11–12 days → ~10–11 days,
- Presenteeism score reduced.
The sums aggregate to form an overall ROI in the iga corridor – assuming clean KPIs, realistic implementation (24 months) and accompanying leadership/BEM measures.
A multi-panel gives a quick 360° view:
Download the white paper “Absenteeism in the modern world of work – from analysis to playbook for decision-makers” here.
