RSPH vs XLV: Grades, Fees and Holdings Compared

Invesco S&P 500 Equal Weight Health Care ETF

RSPHBNYSE Arca

State Street Health Care Select Sector SPDR ETF

XLVANYSE Arca

Overlap

51.2%by weight

Expense ratio

XLV −0.32pt a year

RSPH0.40%XLV0.08%

Avg volume · 30D

XLV 54.2×the volume

RSPH168KXLV9.1M

10Y return · a year

XLV +1.1pt

RSPH+11.5%XLV+12.6%

RSPH vs XLV Performance

Nov 2, 2021 – Nov 2, 2026

+33.8%RSPH+48.8%XLV

Expense ratio: RSPH 0.40%; XLV 0.08%, better
Fund size: RSPH $980M; XLV $48.5B
1Y total return: RSPH +32.8%, better; XLV +30.1%
Yield (12M): RSPH 0.56%; XLV 1.38%, better
Holdings: RSPH 62; XLV 64
Avg volume (30D): RSPH 168K sh; XLV 9.1M sh, better
NAV per share: RSPH $39.69; XLV $184.09
52W range

ETF.net Grade

Pillar letters and Scores for RSPH, XLV, with each pillar’s weight
Pillar	RSPH	XLV
Cost30% weight	B58	A98Higher
Mission25% weight	A78	A84Higher
Risk15% weight	A77	A78Higher
Tradability15% weight	B65	A100Higher
Holdings10% weight	A91Higher	D39
Durability5% weight	B68	A87Higher

Rank among Health Care (Broad) funds

How we build Categories ›

Same Category. RSPH and XLV are both graded against the same 25 Health Care (Broad) funds, so their Grades compare head to head.

Health Care (Broad)⁠

Category · 25 funds

See all 25 ›

XLV ranks 1st and RSPH 7th of 25 funds in the Health Care (Broad) Category.

Rank 1AXLVState Street Health Care Select Sector SPDR ETFScore 85
Rank 2AFHLCFidelity MSCI Health Care Index ETFScore 83
Rank 6BIXJiShares Global Healthcare ETFScore 69
Rank 7BRSPHInvesco S&P 500 Equal Weight Health Care ETFScore 68
Rank 8BPSCHInvesco S&P SmallCap Health Care ETFScore 67

Our read on each fund

ETF.net Research

RSPHBInvesco S&P 500 Equal Weight Health Care ETF

XLVAState Street Health Care Select Sector SPDR ETF

In short

RSPH Health care without the mega-cap gravity: RSPH gives every health care name in the S&P 500 the same slice, so no single drug giant steers the fund. It has been running that way since 2006.

XLV Live since 1998, XLV is the original way to own health care: about 60 S&P 500 names, a 0.08% fee, and one of the busiest tickers in the sector. Big pharma and device makers, not small-cap biotech.

Stated mandate

RSPH The Fund seeks to track the investment results of the S&P 500 Equal Weight Health Care Index.

XLV The fund seeks to track, before expenses, the price and yield performance of the Health Care Select Sector Index, which represents the health care sector of the S&P 500 Index.

Why people hold it

RSPH Equal weighting by design: about 60 S&P 500 health care names, each with the same slice, so one blockbuster drugmaker doesn't set the tone for the basket.
Charges 0.40% a year, below the 0.50% typical of broad health care ETFs.
Live since 2006, through drug-pricing fights, patent cliffs and a pandemic, and rated one of the stronger builds in its health care peer group.
Spread is the point: the portfolio is one of the best-diversified in the cohort, with weight split across the sector rather than parked in a few giants.

XLV 0.08% a year against a cohort median of 0.50%. That ties it with FHLC as the cheapest in the group and edges VHT at 0.09%.
One of the most actively traded funds in its category, which generally keeps bid-ask spreads thin whether you trade 10 shares or 10,000.
Launched December 1998 as one of the first US sector funds, and it has tracked its S&P 500 health care index closely ever since.
Covers the whole sector in one line: pharma, devices, providers, biotech, life-science tools and health tech. Pays quarterly.ssga.com

Worth knowing

RSPH The big cap-weighted rivals cost far less: XLV and FHLC charge 0.08%, VHT 0.09%. You're paying up for the equal-weight tilt.
Equal weight leans toward the sector's smaller members, so results can drift from cap-weighted health care funds in either direction.
One sector, one set of risks: policy shifts, pricing rules and patent cycles move the whole basket at once.

XLV Cap-weighted and about 60 names deep, so the largest drug and device makers carry most of the weight.ssga.com
S&P 500 members only. Mid- and small-cap health care names sit outside the mandate.
One sector, one set of headlines: drug pricing rules, patent expirations and policy shifts move the whole basket together.

Full RSPH profile⁠

Full XLV profile⁠

RSPH vs XLV Holdings

How RSPH and XLV differ

Overlap by weight

51.2%

Shared holdings make up 97.6% of XLV and 96.6% of RSPH.

Level by level

Holdings58 in both51.2%
Sector2 Sectors99.3%
Asset classEquity100%
Countryby domicile100%

Sector

Sector weights in RSPH and XLV, widest gap first
Sector	More in RSPHMore in XLV	RSPH	XLV
Health Care	RSPH +0.7 points	100.0%	99.3%
Technology	XLV +0.7 points	0.0%	0.7%

Country, concentration and asset class

Country by domicile

Country weights in RSPH and XLV, widest gap first
Country	More in RSPHMore in XLV	RSPH	XLV
United States	Same weight	100.0%	100.0%

Concentration

Weight in the 10 largest Holdings

RSPH19.5%
XLV61.0%

Securities held

RSPH61
XLV62

Asset class

RSPH: Equity
XLV: Equity

Holdings

Only in RSPH3
In both58
Only in XLV4

Only in RSPH

3 securities, 3.3% of RSPH by weight

Becton Dickinson & Co1.68%
Elevance Health Inc1.61%
Invesco Government & Agency Portfolio0.02%

Only in XLV

4 securities, 2.2% of XLV by weight

Elevance Health Inc1.37%
Becton Dickinson and Co0.81%
Xav Health Care DEC260.02%
Contra Hologic Incorpo0.00%

Weight gaps

All 58 Holdings in both funds, largest gap first.

Holding weights in RSPH and XLV, widest gap first
Holding	More in RSPHMore in XLV	RSPH	XLV
Eli Lilly & CoLLY	XLV +14.55 points	1.91%	16.46%
Johnson & JohnsonJNJ	XLV +8.37 points	1.56%	9.93%
AbbVie IncABBV	XLV +5.91 points	1.79%	7.70%
UnitedHealth Group IncUNH	XLV +3.95 points	1.57%	5.52%
Merck & Co IncMRK	XLV +3.87 points	1.54%	5.41%
Thermo Fisher Scientific IncTMO	XLV +2.18 points	1.75%	3.93%
Amgen IncAMGN	XLV +1.92 points	1.81%	3.73%
Charles River Laboratories International IncCRL	RSPH +1.70 points	1.97%	0.27%
Revvity IncRVTY	RSPH +1.65 points	1.93%	0.28%
Insulet CorpPODD	RSPH +1.49 points	1.65%	0.16%
Mettler-Toledo International IncMTD	RSPH +1.46 points	1.98%	0.52%
DaVita IncDVA	RSPH +1.46 points	1.56%	0.10%
Viatris IncVTRS	RSPH +1.43 points	1.76%	0.33%
West Pharmaceutical Services IncWST	RSPH +1.43 points	1.87%	0.44%
Universal Health Services IncUHS	RSPH +1.38 points	1.52%	0.14%
Bio-Techne CorpTECH	RSPH +1.36 points	1.53%	0.17%
Henry Schein IncHSIC	RSPH +1.35 points	1.47%	0.12%
Align Technology IncALGN	RSPH +1.34 points	1.49%	0.15%
Gilead Sciences IncGILD	XLV +1.29 points	1.79%	3.08%
Biogen IncBIIB	RSPH +1.28 points	1.83%	0.55%
GE HealthCare Technologies IncGEHC	RSPH +1.27 points	1.79%	0.52%
Labcorp Holdings IncLH	RSPH +1.27 points	1.72%	0.45%
Steris PLCSTE	RSPH +1.27 points	1.61%	0.34%
Baxter International IncBAX	RSPH +1.26 points	1.44%	0.18%
Moderna IncMRNA	RSPH +1.25 points	2.49%	1.24%
Cooper Cos Inc/TheCOO	RSPH +1.25 points	1.43%	0.18%
Zimmer Biomet Holdings IncZBH	RSPH +1.24 points	1.52%	0.28%
Quest Diagnostics IncDGX	RSPH +1.21 points	1.63%	0.42%
Solventum CorpSOLV	RSPH +1.19 points	1.37%	0.18%
Abbott LaboratoriesABT	XLV +1.17 points	1.54%	2.71%
Zoetis IncZTS	RSPH +1.17 points	1.65%	0.48%
Incyte CorpINCY	RSPH +1.15 points	1.45%	0.30%
Veeva Systems IncVEEV	RSPH +1.14 points	1.83%	0.69%
Centene CorpCNC	RSPH +1.12 points	1.63%	0.51%
Illumina IncILMN	RSPH +1.10 points	1.76%	0.66%
Agilent Technologies IncA	RSPH +1.07 points	1.84%	0.77%
ResMed IncRMD	RSPH +1.04 points	1.59%	0.55%
Dexcom IncDXCM	RSPH +1.04 points	1.49%	0.45%
Waters CorpWAT	RSPH +1.03 points	1.74%	0.71%
IDEXX Laboratories IncIDXX	RSPH +0.95 points	1.63%	0.68%
IQVIA Holdings IncIQV	RSPH +0.91 points	1.59%	0.68%
Pfizer IncPFE	XLV +0.89 points	1.67%	2.56%
Humana IncHUM	RSPH +0.83 points	1.58%	0.75%
Edwards Lifesciences CorpEW	RSPH +0.81 points	1.63%	0.82%
Cardinal Health IncCAH	RSPH +0.72 points	1.59%	0.87%
HCA Healthcare IncHCA	RSPH +0.66 points	1.71%	1.05%
Cencora IncCOR	RSPH +0.62 points	1.56%	0.94%
Regeneron Pharmaceuticals IncREGN	RSPH +0.54 points	1.74%	1.20%
Intuitive Surgical IncISRG	XLV +0.51 points	1.86%	2.37%
Boston Scientific CorpBSX	RSPH +0.49 points	1.42%	0.93%
Danaher CorpDHR	XLV +0.49 points	1.73%	2.22%
Cigna Group/TheCI	RSPH +0.45 points	1.63%	1.18%
Vertex Pharmaceuticals IncVRTX	XLV +0.41 points	1.64%	2.05%
Bristol-Myers Squibb CoBMY	XLV +0.40 points	1.48%	1.88%
CVS Health CorpCVS	XLV +0.29 points	1.44%	1.73%
Medtronic PLCMDT	XLV +0.18 points	1.60%	1.78%
Stryker CorpSYK	XLV +0.02 points	1.61%	1.63%
McKesson CorpMCK	XLV +0.01 points	1.70%	1.71%

All 61 RSPH holdings⁠All 61 XLV holdings⁠

How we measure overlap

Each holding counts at its smaller weight in the two funds, summed over the full Holdings. Sector, country and asset class use the same rule on each fund’s split. Cash, FX and derivative lines stay out of the counts. Two bond funds get no overlap figure.

RSPH vs XLV Cost

Overpaying RSPH vs XLV

$6,401

On $10,000 over 30 years. 7% growth a year before fees, expense ratio only.

RSPH 0.40%
$8,090
XLV 0.08%
$1,689

Amount$10,000

Years30 years

Cost over time

RSPH 0.40%
XLV 0.08%
Overpaying

Year by year

Year	RSPH	XLV	Overpaying
10	$723	$147	$576
20	$2,793	$575	$2,218
30	$8,090	$1,689	$6,401

Expense ratio

0.40%RSPH
0.08%XLV, cheaper

XLV0.08%RSPH0.40%

0.08%0.85%

Middle half of Health Care (Broad) funds
Median 0.50%

XLV cheapest of 25 funds

RSPH 11th cheapest of 25 funds

RSPH vs XLV Dividends

Last 12 months to Nov 2, 2026

Yield (12M): RSPH 0.56%; XLV 1.38%, better
Payout (12M): RSPH $0.22; XLV $2.55
Last payment: RSPH $0.05; XLV $0.64
Ex-dividend: RSPH Sep 21, 2026; XLV Sep 21, 2026
Paid on: RSPH Sep 25, 2026; XLV Sep 23, 2026
Frequency: RSPH Quarterly; XLV Quarterly

Distribution history

Per share, 2017 to 2026, same scale for both

RSPHQuarterly · 39 paymentsAll RSPH payments⁠

XLVQuarterly · 40 paymentsAll XLV payments⁠

RSPH vs XLV Risk

Fall from peak · 5 years

RSPH
XLV

Risk facts

VolatilityStd dev, 3 years: RSPH 15.4%XLV 14.8%, better
Return per unit of riskSharpe ratio, 3 years: RSPH 0.79, betterXLV 0.78
Worst fallMax drawdown, 5 years: RSPH −21.9%XLV −17.1%, better
Market sensitivityBeta, 5 years: RSPH 0.78XLV 0.56; Market = 1

RSPH and XLV in the news

All news⁠

Category Review
Health care funds trail the S&P 500 this year
Updated Oct 7, 2026RSPHXLV
Deep Dive
Eli Lilly is 15% of the biggest health care ETF
Sep 25, 2026RSPHXLV
Deep Dive
Health care's 1.8% week was four large caps, not a biotech rally
Sep 19, 2026RSPHXLV
Deep Dive
Health care ETFs spent 2026 between a 28% biotech rally and a 16% device slide
Sep 14, 2026RSPHXLV
The Big Picture
Two-year Treasury yield fell 11 basis points alongside the AI share selloff
Oct 31, 2026XLV
Top Movers
Alphabet fell 12.6%, but the average stock rose
Oct 29, 2026XLV

Popular comparisons

RSPHBvsFHLCA
Invesco S&P 500 Equal Weight Health Care ETF · Fidelity MSCI Health Care Index ETF
Expense ratio
0.40% · 0.08%
Category
XLVAvsFHLCA
State Street Health Care Select Sector SPDR ETF · Fidelity MSCI Health Care Index ETF
Expense ratio
0.08% · 0.08%
Category
RSPHBvsVHTA
Invesco S&P 500 Equal Weight Health Care ETF · Vanguard Health Care ETF
Expense ratio
0.40% · 0.09%
Category
XLVAvsVHTA
State Street Health Care Select Sector SPDR ETF · Vanguard Health Care ETF
Expense ratio
0.08% · 0.09%
Category
RSPHBvsXHSA
Invesco S&P 500 Equal Weight Health Care ETF · State Street SPDR S&P Health Care Services ETF
Expense ratio
0.40% · 0.35%
Category
XLVAvsXHSA
State Street Health Care Select Sector SPDR ETF · State Street SPDR S&P Health Care Services ETF
Expense ratio
0.08% · 0.35%
Category

RSPH vs XLV

In short

Stated mandate

Why people hold it