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DURHAM, N.C. –- Religion may help cut the nation's health care costs, according to a study by a Duke psychiatrist.

In a study of religion's impact on health care costs, Dr. Harold Koenig found that religious elderly patients cost the U.S. health care system less money than patients who were less religious. Of the 542 patients studied, those who attended religious services once a week or more were 43 percent less likely to have been hospitalized in the previous year than people who never attended or only went a few times a year.

In addition, religious patients reported spending just six days in the hospital during the previous year compared to 12 days among less observant patients. His research, funded by the National Institute of Mental Health, is published in the October issue of the Southern Medical Journal.

Koenig said his findings are important in the face of escalating health care costs and the aging population of baby boomers who will tax the health care system in the coming years. According to the U.S. Senate Special Committee on aging, people over 60 are hospitalized twice as often as younger adults and account for almost 50 percent of all short-stay hospital days. They are also the fastest growing segment of the American population.

"Anything that reduces health care costs deserves careful attention in the hopes of lessening the burden on both the health care system and the elderly, who happen to use a disproportionate amount of acute hospital services," Koenig said.

Despite shortened hospital stays and the shift to outpatient procedures, the cost of acute medical hospitalizations still continues to dwarf all other medical expenditures, the Senate report concluded. In 1994, Medicare paid out over $80 billion for acute inpatient services compared to $40 billion for physician services and just $5 billion for nursing home care.

If religious affiliation can promote health and reduce costs, Koenig believes it is worth physicians' time to support their patients' religious habits.

"Religious participation doesn't cost much and it is widely available throughout the country," Koenig said. "While we don't suggest that elderly people join and participate in a religious community just for the health benefits, we do suggest that physicians and health care providers encourage already religious patients to continue their involvement, and to promote chaplain services that allow patients' spiritual needs to be met," Koenig said.

As the basis of his recommendation, Koenig refers to more than a dozen studies he has conducted in the past five years showing the benefits of religion on health in the elderly. Among his published findings are those showing religious elderly are less depressed, have stronger immune systems and have lower blood pressure.

Now, he hopes to apply that body of research to the bottom line of health care costs, in an effort to find practical ways to solve an escalating national health care dilemma.

In the new study, aimed at quantifying the benefits of religion on the bottom line, Koenig surveyed the religious habits of 542 patients over the age of 60 who had come to Duke University Hospital for acute medical care. In the first part of the study, he polled patients about their religious affiliations, religious participation and hospital use.

He found that patients who attended religious services once a week or more were 56 percent less likely to have been hospitalized during the previous year. After controlling for severity of medical illness, physical functioning, social support, depressive symptoms, age, gender, race and education, frequent attenders were still 43 percent less likely to have been in the hospital. They also spent fewer days in the hospital in the previous year: six days for frequent attenders versus 12 days for infrequent attenders.

In the second part of the study, Koenig measured the length of time each patient remained in Duke Hospital during the current hospital admission, then compared it with their religious affiliation. He found that patients with no religious affiliation were hospitalized an average of 25 days, compared to only 11 days for people who claimed a religious affiliation (Catholic, Protestant or Jewish). The difference in length of stay remained even when the researchers controlled for the same variables as in the first phase of the study.

Researchers aren't sure why this effect occurs, but they say it cannot be fully explained by the social and emotional support derived from fellow congregants, since the researchers controlled for this effect. Plausible reasons include the notion that church-goers experience less despair and stress because they rely on divine intervention to help them through hard times, or that being part of a caring community contributes to earlier diagnosis and reporting of health problems, thereby reducing the incidence of acute hospitalization.

Finally, frequent church attenders may simply be healthier than infrequent attenders, whose disabilities prevent them from going. Nevertheless, better physical health could not account entirely for the associations found in the study, which seemed independent of health status, Koenig said.