[Effects of decreasing sick leave benefits--results of a survey of Social Health Insurance members].

In Germany, a sick employee usually continues to get his wages from his employer for six weeks either in full or reduced. After that period, he only receives "sick benefit payments" (so-called Krankengeld) from the statutory bodies, which, up to 31 December 1996, amounted to 80% of his original gross wage earnings. This has been cut down to 70% of the gross wage earnings effective 1 January 1997. The purpose of this study was to assess the consequences of this general cutdown of sick benefits. A standardised questionnaire was posted to a total of 7,036 female recipients of sick benefit who were members of a South German statutory health insurance body and who resided in various parts of Germany (membership as on 17 December 1996). 2,416 completed questionnaires were returned by 19 February 1997 (= 34.9%). The average daily sick benefit payment dropped from DM 91.95 in December 1996 to DM 82.39 in January 1997, which is equivalent to a sick benefit payment reduction by 10.4 per cent. The average extra cost caused by the illness and not covered by sick benefit amounted to DM 152 per month; one-quarter of the questioned patients were even compelled to pay DM 200 per month extra from their own pocket. Sick benefit recipients must accept a very substantial real monthly income loss. The average income of an employee who is ill for more than 6 weeks is more than a quarter below that of a healthy employee. 78.5% of the questioned persons rated the financial burden and privations caused by the sick benefit cutdown as "extremely heavy" or "considerable". It became evident that the majority of the female patients receiving sick benefit were chronically ill (62.6%). The most frequently reported diseases were diseases of the spine (30.3%) and joints (16.3%), injuries and accidents (14%) and psychiatric illnesses (8.5%). The results of the survey show that the political motive underlying the attempted modification of illness behaviour by means of economic incentives to be healthy, is far removed from reality, for the cutdown of sickness benefit severely affects a group of gainfully employed persons who are in the midst of a deep existential crisis and sorely in need of extensive physical and mental support. From the sociomedical aspect the sick benefit cutdown is highly problematical as far as this group of persons is concerned, since recovery and cure are impeded by measures that lower the status and are experienced as punitive.