The CEOs of the United States' leading companies anticipate increased capital expenditures and sales over the next six months, but do not expect employment to significantly improve, according to the results of Business Roundtable's fourth quarter CEO Economic Outlook Survey. According to the survey results, only 19 percent expect to grow their work forces over the next half-year, while 31 percent predict a decrease in employment. This is an improvement over the third-quarter survey, when only 13 percent planned increases and 40 percent planned to cut. CEOs who expect to increase capital spending grew to 40 percent, up from 21 percent last quarter; 68 percent forecast an increase in sales, up from 51 percent last quarter. "The economy is in the throes of a long transition back to health; recovery will be long, extending beyond 2010," says Ivan G. Seidenberg, chair of Business Roundtable and chair and CEO of Verizon Communications. The survey's economic outlook index expanded to 71.5 for the fourth quarter, an significant increase from 44.9 last quarter; the index combines CEO projections for sales, capital spending, and employment, with 50 as its center. Those surveyed cited increased healthcare costs as their top concern going into the new year. "Healthcare is a significant -- and growing -- concern for our companies," says Seidenberg. "This underscores the urgent need for the right kind of healthcare reform that can achieve real and permanent cost reductions. Without reform, these costs will continue to weigh down the economy and hinder job creation when we need it most."