All rights reserved. No part of this book may be reproduced in any form by any electronic or mechanical means (including photocopying, recording, or information storage and retrieval) without permission in writing from RAND.The RAND Corporation is a nonprofit research organization providing objective analysis and effective solutions that address the challenges facing the public and private sectors around the world. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.R ® is a registered trademark.iii PrefaceThis report has been commissioned by, and prepared for and in collaboration with, the National Audit Office (NAO). Its objective is to provide an estimation of the current financial impact of caring for patients during their last year (365 days) of life in England and to simulate the expected benefits of expanding the reach of palliative care services and respecting peoples' expressed wishes for the place where they want to receive care at the end of their life.This study contributes to the limited economic literature on the economics of palliative care. It demonstrates the benefits of increasing the reach of palliative care services and improving the quality of care while avoiding hospitalisations that do not offer additional benefits to patients close to the end of their life. This report will be of interest to healthcare providers, healthcare users, healthcare insurers and policy makers.RAND Europe is an independent not-for-profit policy research organisation that aims to serve the public interest by improving policymaking and informing public debate. Its clients are European governments, institutions and firms with a need for rigorous, impartial, multidisciplinary analysis. This report has been peer-reviewed in accordance with RAND's quality assurance standards.

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Abstract-The 1986 Adult Use of Tobacco Survey conducted by the Office on Smoking and Health of the Centers for Disease Control asked detailed questions on smoking behavior from a representative sample of 13,031 Americans. Using a smoking continuum developed from that survey as an index, it was postulated that a hard-core group of smokers would be overrepresented in some ca tegories of this continuum in certain groups of the population. In this survey, more women than men who had quit in the preceding year had relapsed to smoking by the time of the survey. However, the fact that similar proportions of men and women had quit smoking for between one and five years suggested that the difference might not have involved the proportion who relapsed but only the timing of that relapse. Smokers over the age of 65 are more likely both to attempt to quit and to continue abstaining than those between ages 25 and 64. Results from this survey do not indicate a major group of smokers who either resist change or who feel unable to quit successfully.Keywords--age, sex, smoking behavior, smoking cessation, smoking continuum Cigarette smoking has long been identified as one of the most significant causes of death in the United States. Smoking is responsible for an estimated 30% of all cancer deaths (including 87% of all deaths from lung cancer), 21% of all deaths from coronary heart disease, 18% of all deaths from stroke, and 82% of all deaths from chronic obstructive pulmonary disease. In total, one-sixth of all deaths in the U.S. (approximately 390,000 in 1985) are smoking related

The RAND Corporation is a nonprofit research organization providing objective analysis and effective solutions that address the challenges facing the public and private sectors around the world. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors. R ® is a registered trademark.

RAND Review is published periodically by the RAND Corporation, a nonprofi t institution. The mission of the RAND Corporation is to help improve policy and decisionmaking through research and analysis. Opinions are those of the authors and do not refl ect positions taken by RAND, its board, or its clients.