VHT vs XHS: Grades, Fees and Holdings Compared

Vanguard Health Care ETF

VHTANYSE Arca

State Street SPDR S&P Health Care Services ETF

XHSANYSE Arca

Overlap

13.6%by weight

Expense ratio

VHT −0.26pt a year

VHT0.09%XHS0.35%

Avg volume · 30D

VHT 7.4×the volume

VHT237KXHS31.9K

10Y return · a year

VHT +0.9pt

VHT+12.4%XHS+11.5%

VHT vs XHS Performance

Oct 29, 2021 – Oct 30, 2026

+42.5%VHT+36.6%XHS

Expense ratio: VHT 0.09%, better; XHS 0.35%
Fund size: VHT $21.8B; XHS $234M
1Y total return: VHT +28.7%; XHS +39.7%, better
Yield (12M): VHT 1.35%, better; XHS 0.15%
Holdings: VHT 413; XHS 63
Avg volume (30D): VHT 237K sh, better; XHS 31.9K sh
NAV per share: VHT $342.46; XHS $144.25
52W range

ETF.net Grade

Pillar letters and Scores for VHT, XHS, with each pillar’s weight
Pillar	VHT	XHS
Cost30% weight	A92Higher	A81
Mission25% weight	A82	Not scored
Risk15% weight	A79Higher	A78
Tradability15% weight	B57Higher	C54
Holdings10% weight	B58	A87Higher
Durability5% weight	A92Higher	B64

Rank among Health Care (Broad) funds

How we build Categories ›

Same Category. VHT and XHS 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 ›

VHT ranks 3rd and XHS 4th 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 3AVHTVanguard Health Care ETFScore 77
Rank 4AXHSState Street SPDR S&P Health Care Services ETFScore 74
Rank 5AIYHiShares U.S. Healthcare ETFScore 71

Our read on each fund

ETF.net Research

VHTAVanguard Health Care ETF

XHSAState Street SPDR S&P Health Care Services ETF

In short

VHT The whole US health care sector in one ticket: roughly 400 stocks, an index that reaches well past the megacaps, and a nine-basis-point fee. Trading since 2004, it is one of the category's originals.

XHS Most health care ETFs are pharma funds in disguise. XHS buys the delivery system instead: insurers, hospitals, distributors and clinics, roughly equal weighted so one giant insurer does not run the show.

Stated mandate

VHT The fund seeks to track a benchmark index measuring the investment return of health care stocks.

XHS The fund seeks to track the total return of the S&P Health Care Services Select Industry Index before fees and expenses, providing targeted exposure to health care services companies.

Why people hold it

VHT Costs 0.09% a year while the typical fund in its health care peer group charges 0.50%. Same sector, a fraction of the toll.
Roughly 400 holdings drawn from an investable-market index, so mid and small health care companies count too, not just the sector's giants.vanguard.com
Two decades old, now a multi-billion-dollar fund, moderately traded, and it has hugged its benchmark closely. Pays out quarterly.
On cost, tracking and tradability together, it stands among the strongest builds in a 24-fund health care cohort.

XHS No drugmakers, no device makers. The index tracks four slices of care delivery: distributors, facilities, health care services and managed care.ssga.com
Modified equal weighting spreads about 60 names across large, mid and small caps, so the portfolio is not a bet on two or three mega caps.ssga.com
0.35% a year sits below the 0.50% median for broad health care ETFs, on a fund that has been running since 2011.
Ranks in the top quartile of the broad health care ETFs we grade.

Worth knowing

VHT FHLC and XLV each shave a basis point off the fee. If the fee line is your only tiebreaker, VHT is not the final word.
One sector, one news cycle. Drug pricing rules, patent expirations and regulatory decisions can move the entire basket at once.vanguard.com
Cap-weighted with a 25/50 diversification rule, so no single name can dominate outright, but the largest pharma and insurer positions still steer most of the ride.vanguard.com

XHS Cheap against the median, not against the giants: XLV, VHT and FHLC charge under a tenth of a percent for cap weighted whole sector exposure.
Thinly traded next to the big sector funds, so spreads and limit orders matter more here.
Leaving out pharma and biotech means it moves differently from a whole sector fund, and insurers and hospitals sit close to reimbursement policy.ssga.com

Full VHT profile⁠

Full XHS profile⁠

VHT vs XHS Holdings

How VHT and XHS differ

Overlap by weight

13.6%

Shared holdings make up 94.1% of XHS and 16.6% of VHT.

Level by level

Holdings57 in both13.6%
Sector4 Sectors98.1%
Asset classEquity100%
Countryby domicile100%

Sector

Sector weights in VHT and XHS, widest gap first
Sector	More in VHTMore in XHS	VHT	XHS
Financials	XHS +1.9 points	0.0%	1.9%
Health Care	VHT +1.9 points	100.0%	98.1%
Industrials	Same weight	0.0%	0.0%
Technology	Same weight	0.0%	0.0%

Country, concentration and asset class

Country by domicile

Country weights in VHT and XHS, widest gap first
Country	More in VHTMore in XHS	VHT	XHS
United States	Same weight	100.0%	100.0%

Concentration

Weight in the 10 largest Holdings

VHT51.8%
XHS20.7%

Securities held

VHT411
XHS61

Asset class

VHT: Equity
XHS: Equity

Holdings

Only in VHT354
In both57
Only in XHS4

Only in VHT

354 securities, 83.2% of VHT by weight

Eli Lilly & Co12.95%
Johnson & Johnson8.79%
AbbVie Inc6.46%
Merck & Co Inc5.02%
Thermo Fisher Scientific Inc3.51%
Amgen Inc3.18%
Gilead Sciences Inc2.59%
Abbott Laboratories2.41%
Pfizer Inc2.27%
Intuitive Surgical Inc2.01%
Danaher Corp1.97%
Vertex Pharmaceuticals Inc1.86%
Bristol-Myers Squibb Co1.78%
Medtronic PLC1.54%
Stryker Corp1.33%
Regeneron Pharmaceuticals Inc1.09%
Moderna Inc0.91%
Boston Scientific Corp0.91%
Natera Inc0.79%
Edwards Lifesciences Corp0.69%
Becton Dickinson & Co0.69%
Agilent Technologies Inc0.68%
IQVIA Holdings Inc0.63%
Waters Corp0.60%
Veeva Systems Inc0.58%
IDEXX Laboratories Inc0.58%
Illumina Inc0.56%
Revolution Medicines Inc0.49%
Biogen Inc0.47%
Dexcom Inc0.47%
Alnylam Pharmaceuticals Inc0.46%
ResMed Inc0.45%
Mettler-Toledo International Inc0.43%
GE HealthCare Technologies Inc0.42%
Zoetis Inc0.41%
West Pharmaceutical Services Inc0.37%
Insmed Inc0.34%
United Therapeutics Corp0.29%
Viatris Inc0.29%
Incyte Corp0.29%
Steris PLC0.29%
Roivant Sciences Ltd0.27%
Zimmer Biomet Holdings Inc0.24%
Revvity Inc0.24%
Medpace Holdings Inc0.20%
Charles River Laboratories International Inc0.20%
Exelixis Inc0.19%
Neurocrine Biosciences Inc0.19%
Jazz Pharmaceuticals PLC0.19%
Halozyme Therapeutics Inc0.18%

Only in XHS

4 securities, 5.8% of XHS by weight

Billiontoone Inc Class A1.90%
Nutex Health Inc1.75%
Sonida Senior Living Inc1.42%
Strata Critical Medical Inc0.72%

Weight gaps

All 57 Holdings in both funds, largest gap first.

Holding weights in VHT and XHS, widest gap first
Holding	More in VHTMore in XHS	VHT	XHS
UnitedHealth Group IncUNH	VHT +2.94 points	4.66%	1.72%
Surgery Partners IncSGRY	XHS +2.69 points	0.02%	2.71%
AMN Healthcare Services IncAMN	XHS +2.23 points	0.02%	2.25%
Option Care Health IncOPCH	XHS +2.17 points	0.05%	2.22%
Hinge Health IncHNGE	XHS +2.05 points	0.06%	2.11%
Concentra Group Holdings Parent IncCON	XHS +1.92 points	0.06%	1.98%
CorVel CorpCRVL	XHS +1.90 points	0.03%	1.93%
US Physical Therapy IncUSPH	XHS +1.81 points	0.02%	1.83%
PACS Group IncPACS	XHS +1.80 points	0.03%	1.83%
Privia Health Group IncPRVA	XHS +1.74 points	0.03%	1.77%
Pediatrix Medical Group IncMD	XHS +1.74 points	0.03%	1.77%
LifeStance Health Group IncLFST	XHS +1.74 points	0.04%	1.78%
Clover Health Investments CorpCLOV	XHS +1.72 points	0.02%	1.74%
Progyny IncPGNY	XHS +1.69 points	0.03%	1.72%
HealthEquity IncHQY	XHS +1.70 points	0.10%	1.80%
Acadia Healthcare Co IncACHC	XHS +1.69 points	0.03%	1.72%
Addus HomeCare CorpADUS	XHS +1.69 points	0.03%	1.72%
Hims & Hers Health IncHIMS	XHS +1.67 points	0.08%	1.75%
DaVita IncDVA	XHS +1.66 points	0.08%	1.74%
Ensign Group Inc/TheENSG	XHS +1.64 points	0.14%	1.78%
RadNet IncRDNT	XHS +1.65 points	0.06%	1.71%
NeoGenomics IncNEO	XHS +1.64 points	0.03%	1.67%
Chemed CorpCHE	XHS +1.63 points	0.09%	1.72%
Encompass Health CorpEHC	XHS +1.61 points	0.17%	1.78%
Guardant Health IncGH	XHS +1.56 points	0.31%	1.87%
Astrana Health IncASTH	XHS +1.56 points	0.02%	1.58%
Molina Healthcare IncMOH	XHS +1.55 points	0.14%	1.69%
Aveanna Healthcare Holdings IncAVAH	XHS +1.54 points	0.02%	1.56%
Labcorp Holdings IncLH	XHS +1.54 points	0.35%	1.89%
Universal Health Services IncUHS	XHS +1.53 points	0.12%	1.65%
Guardian Pharmacy Services IncGRDN	XHS +1.51 points	0.02%	1.53%
Henry Schein IncHSIC	XHS +1.51 points	0.11%	1.62%
agilon health IncAGL	XHS +1.50 points	0.01%	1.51%
National HealthCare CorpNHC	XHS +1.50 points	0.04%	1.54%
Omada Health IncOMDA	XHS +1.49 points	0.01%	1.50%
BrightSpring Health Services IncBTSG	XHS +1.47 points	0.13%	1.60%
Castle Biosciences IncCSTL	XHS +1.41 points	0.01%	1.42%
Quest Diagnostics IncDGX	XHS +1.41 points	0.36%	1.77%
Pennant Group Inc/ThePNTG	XHS +1.37 points	0.02%	1.39%
Brookdale Senior Living IncBKD	XHS +1.36 points	0.03%	1.39%
Tenet Healthcare CorpTHC	XHS +1.34 points	0.31%	1.65%
Centene CorpCNC	XHS +1.33 points	0.43%	1.76%
GeneDx Holdings CorpWGS	XHS +1.33 points	0.02%	1.35%
AdaptHealth CorpAHCO	XHS +1.31 points	<0.01%	1.32%
Starling Oncology IncSTLN	XHS +1.17 points	<0.01%	1.18%
Humana IncHUM	XHS +1.07 points	0.64%	1.71%
Alignment Healthcare IncALHC	XHS +1.00 points	0.02%	1.02%
Cardinal Health IncCAH	XHS +0.99 points	0.73%	1.72%
HCA Healthcare IncHCA	XHS +0.93 points	0.93%	1.86%
Cencora IncCOR	XHS +0.90 points	0.78%	1.68%
Cigna Group/TheCI	XHS +0.75 points	1.01%	1.76%
Fulgent Genetics IncFLGT	XHS +0.74 points	<0.01%	0.75%
Elevance Health IncELV	XHS +0.60 points	1.15%	1.75%
OPKO Health IncOPK	XHS +0.53 points	<0.01%	0.54%
Community Health Systems IncCYH	XHS +0.43 points	<0.01%	0.43%
McKesson CorpMCK	XHS +0.41 points	1.40%	1.81%
CVS Health CorpCVS	XHS +0.03 points	1.53%	1.56%

All 411 VHT holdings⁠All 61 XHS 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.

VHT vs XHS Cost

Overpaying XHS vs VHT

$5,228

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

VHT 0.09%
$1,898
XHS 0.35%
$7,126

Amount$10,000

Years30 years

Cost over time

VHT 0.09%
XHS 0.35%
Overpaying

Year by year

Year	VHT	XHS	Overpaying
10	$165	$634	$469
20	$646	$2,454	$1,808
30	$1,898	$7,126	$5,228

Expense ratio

0.09%VHT, cheaper
0.35%XHS

VHT0.09%XHS0.35%

0.08%0.85%

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

VHT 3rd cheapest of 25 funds

XHS 5th cheapest of 25 funds

VHT vs XHS Dividends

Last 12 months to Oct 30, 2026

Yield (12M): VHT 1.35%, better; XHS 0.15%
Payout (12M): VHT $4.61; XHS $0.21
Last payment: VHT $0.97; XHS $0.01
Ex-dividend: VHT Sep 23, 2026; XHS Sep 21, 2026
Paid on: VHT Sep 25, 2026; XHS Sep 23, 2026
Frequency: VHT Quarterly; XHS Quarterly

Distribution history

Per share, 2017 to 2026, same scale for both

VHTQuarterly · 39 paymentsAll VHT payments⁠

XHSQuarterly · 39 paymentsAll XHS payments⁠

VHT vs XHS Risk

Fall from peak · 5 years

Risk facts

VolatilityStd dev, 3 years: VHT 14.5%, betterXHS 20.8%
Return per unit of riskSharpe ratio, 3 years: VHT 0.83XHS 0.85, better
Worst fallMax drawdown, 5 years: VHT −17.7%, betterXHS −30.0%
Market sensitivityBeta, 5 years: VHT 0.59XHS 0.93; Market = 1

VHT and XHS in the news

All news⁠

Deep Dive
Health care ETFs spent 2026 between a 28% biotech rally and a 16% device slide
Sep 14, 2026VHTXHS
Category Review
Health care funds trail the S&P 500 this year
Updated Oct 7, 2026VHT
Deep Dive
Eli Lilly is 15% of the biggest health care ETF
Sep 25, 2026VHT
Deep Dive
Health care's 1.8% week was four large caps, not a biotech rally
Sep 19, 2026XHS

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VHT vs XHS

In short

Stated mandate

Why people hold it

Worth knowing

How VHT and XHS differ

Level by level

Sector

Country, concentration and asset class

Country by domicile

Concentration

Asset class

Holdings

Only in VHT

Only in XHS

Weight gaps

Cost over time

Year by year

Distribution history

Fall from peak · 5 years

Risk facts

Health care ETFs spent 2026 between a 28% biotech rally and a 16% device slide

Health care funds trail the S&P 500 this year

Eli Lilly is 15% of the biggest health care ETF

Health care's 1.8% week was four large caps, not a biotech rally

How VHT and XHS differ

Level by level

Sector

Country, concentration and asset class

Country by domicile

Concentration

Asset class

Holdings

Only in VHT

Only in XHS

Weight gaps