What are healthcare services ETFs?
Healthcare services companies deliver and manage care rather than discover new treatments. They include insurers, hospital and clinic operators, labs and the firms that supply them with data. The six ETFs here stretch that label. Some stick to U.S. healthcare providers and services, while others add drugmakers focused on weight loss and heart health, or health technology companies. As a result, no stock appears in more than half of them. Veeva Systems and Hims & Hers Health each show up in three funds. Eli Lilly, UnitedHealth Group, IQVIA, Merck, GE HealthCare, Dexcom, AstraZeneca, ResMed, Intuitive Surgical and Insulet each appear in two.
Four funds track indexes, which are rule-based lists of stocks. IHF (iShares) follows an index of U.S. healthcare providers, and XHS (SPDR) follows an S&P index of U.S. health care providers and services. HEAL (Global X) tracks the Global X HealthTech Index, and THNR (Amplify) tracks the VettaFi Weight Loss Drug & Treatment Index. HRTS (Tema, since renamed Tema Heart & Health ETF) and LGHT (Langar) aim for long-term growth of capital instead of matching an index. IHF is highly concentrated, with 72% of assets in its top 10 stocks and 21.9% in UnitedHealth Group. XHS holds the same number of stocks, 61, but has only about 20% in its top 10. None of the six uses leverage, inverse bets or options.
Expense ratios, the yearly fee taken from a fund's assets, run from 0.35% for XHS to 0.85% for LGHT, with a median of 0.50%. IHF sits near the low end at 0.37%.
The money is lopsided. The six funds held about $1.40 billion, and IHF alone had about $1.18 billion of it. The five largest funds hold 99.8% of the total, which leaves LGHT, with about $2.5 million, a sliver.
Healthcare services ETF holdings: the stocks most funds own
The stocks that show up most often among the largest positions of the 6 biggest healthcare services ETFs with holdings reports, from their latest N-PORT filings.
| Stock | Funds holding it | Typical weight |
|---|---|---|
| Veeva Systems Inc. | 3 of 6 | 4.13% |
| Hims & Hers Health Inc | 3 of 6 | 3.9% |
| Eli Lilly & Co | 2 of 6 | 9.26% |
| Unitedhealth Group Incorporated | 2 of 6 | 5.24% |
| Iqvia Holdings Inc | 2 of 6 | 4.72% |
| Merck & Co Inc | 2 of 6 | 4.27% |
| Ge Healthcare Technologies Inc. | 2 of 6 | 4.17% |
| Dexcom, Inc. | 2 of 6 | 4.01% |
| AstraZeneca PLC | 2 of 6 | 4% |
| Resmed Inc. | 2 of 6 | 3.78% |
| Intuitive Surgical, Inc. | 2 of 6 | 3.77% |
| Insulet Corporation | 2 of 6 | 3.38% |
Typical weight is the median share of each fund’s assets in the stock, among the funds that hold it in their 25 largest positions.
The largest healthcare services ETFs, side by side
Swipe the table to see all 5 funds.
| IHF | XHS | HRTS | HEAL | THNR | |
|---|---|---|---|---|---|
| Net assets | $1.18B | $139.9M | $51.9M | $25.0M | $4.4M |
| Expense ratio | 0.37% | 0.35% | 0.75% | 0.5% | 0.59% |
| Holdings | 61 | 61 | 44 | 40 | 20 |
| In the 10 largest | 72.13% | 20.35% | 49.14% | 42.33% | 60.21% |
| Biggest holding | Unitedhealth Group Incorporated (21.91%) | LifeStance Health Group Inc (2.2%) | Eli Lilly & Co (11.52%) | Dexcom, Inc. (4.89%) | Novo Nordisk A/S (9.76%) |
| Yield | 0.91% | 0.15% | 1.25% | 0.23% | 1.67% |
| 1-year return | +16.5% | +33.7% | +16.6% | -6.4% | +8.1% |
| 3 years, a year | +7.7% | +22.1% | — | — | — |
| 5 years, a year | +2.4% | +6.8% | — | — | — |
| Worst drop, past year | -19.7% | -12.0% | -11.0% | -30.1% | -13.9% |
| Launched | 2006 | 2011 | 2023 | 2020 | 2024 |
The largest ordinary funds by net assets (leveraged and inverse funds are listed further down). Holdings from each fund’s latest N-PORT report; returns include reinvested distributions, as of Oct 27, 2026.
Head to head
IHF vs XHS
IHF and XHS each hold 61 U.S. stocks, and 50 are shared, worth 39.3% of assets, yet they weight them very differently. IHF leans on giants: its top 10 are 72% of the fund and UnitedHealth Group alone is 21.9%. XHS spreads out, with about 20% in its top 10 and a largest holding, LifeStance Health Group, of 2.2%. Fees are close: 0.37% versus 0.35%. In the year to May 16, 2025, XHS gained 10.3% and IHF lost 9.7%, with worst drops of 12.3% and 19.8%, respectively. IHF may suit those wanting the biggest names; XHS, those preferring money spread more widely.
HRTS vs THNR
HRTS and THNR both center on obesity treatments, sharing 11 holdings worth 27.9% of assets. HRTS aims for long-term growth rather than tracking an index; its 44 stocks put 49% in the top 10, led by Eli Lilly at 11.5%. THNR tracks the VettaFi Weight Loss Drug & Treatment Index, with 20 stocks, 60% in the top 10 and Novo Nordisk first at 9.8%. THNR costs 0.59%, HRTS 0.75%. HRTS lost 16% in the year to May 16, 2025; THNR, not yet a year old, saw a worst drop of 32.5%, against HRTS's 25.8%. Either may suit investors wanting a narrow theme.
IHF vs HEAL
IHF and HEAL barely overlap: 13 shared holdings worth 8.6% of assets. IHF tracks U.S. healthcare providers and is top-heavy, with 72% in its top 10 and UnitedHealth Group at 21.9%. HEAL tracks the Global X HealthTech Index across 40 stocks, with 42% in its top 10 and Dexcom largest at 4.9%. HEAL costs 0.50% to IHF's 0.37%. In the year to May 16, 2025, HEAL gained 12.7% and IHF lost 9.7%, but HEAL's worst drop was deeper, 28% versus 19.8%. IHF may suit investors focused on large providers; HEAL, those seeking health technology.
How much do the largest healthcare services ETFs overlap?
Owning two funds that hold the same stocks adds little diversification. Overlap here is the share of assets two funds have in common: for each stock both own, the smaller of its two weights, added up.
| Funds | Assets in common | Shared holdings | |
|---|---|---|---|
| IHF and XHS | 39.3% | 50 | |
| HRTS and THNR | 27.9% | 11 | |
| XHS and HEAL | 11.5% | 7 | |
| IHF and HEAL | 8.6% | 13 | |
| IHF and HRTS | 5.2% | 1 | |
| HRTS and HEAL | 4% | 3 | |
| HEAL and THNR | 3.9% | 1 | |
| XHS and HRTS | 3.2% | 2 | |
| XHS and THNR | 2% | 1 | |
| IHF and THNR | 1.1% | 1 |
From each fund’s full holdings in its latest N-PORT report.
How have healthcare services ETFs performed?
The five largest ordinary funds: growth from the start of the range, distributions reinvested. The dashed gray line is the S&P 500 (SPY).
Best-performing healthcare services ETFs over the past year
| # | Fund | Net assets | Cost | 1 mo | YTD | 1 yr | 3 yr |
|---|---|---|---|---|---|---|---|
| 1 | XHS SPDR S&P Health Care Services ETF | $139.9M | 0.35% | +4.6% | +32.0% | +33.7% | +22.1% |
| 2 | HRTS Tema GLP-1 Obesity & Cardiometabolic ETF | $51.9M | 0.75% | +3.6% | +6.6% | +16.6% | — |
| 3 | IHF iShares U.S. Healthcare Providers ETF | $1.18B | 0.37% | +6.1% | +24.5% | +16.5% | +7.7% |
| 4 | HEAL Global X HealthTech ETF | $25.0M | 0.5% | +5.8% | +6.2% | -6.4% | — |
Funds with at least $25 million in net assets; leveraged and inverse funds left out. Past returns don’t predict future returns.
How healthcare services ETFs did in past market crashes
| Fund | 2008 crash | 2020 crash | 2022 drop |
|---|---|---|---|
| IHF | -54.8% | -35.2% | -12.3% |
| XHS | not yet launched | not yet launched | -17.5% |
| HRTS | not yet launched | not yet launched | not yet launched |
| HEAL | not yet launched | not yet launched | not yet launched |
| THNR | not yet launched | not yet launched | not yet launched |
| S&P 500 (SPY) | -55.2% | -33.7% | -24.5% |
Total return from the stock market’s peak to its low in each fall, distributions reinvested.
What drives healthcare services ETFs?
Insurers and care providers make money on the gap between what they collect and what patients' care ends up costing. That money comes from premiums, employers and government programs such as Medicare and Medicaid. When people use more care than expected, or when the government changes payment rates or rules, profits can shift across the whole group at once. The drugmakers in HRTS and THNR rise and fall with trial results, regulatory approvals and competition. The health technology firms in HEAL and LGHT tend to trade like growth stocks. Those can be sensitive to interest rates because more of their expected profits lie further in the future.
Steady demand for care has not always protected these funds. In the 2008 financial crisis, IHF fell 54.8%, nearly matching the S&P 500's 55.2% drop. In the 2020 COVID crash, IHF lost 35.2% and XHS 39.3%, more than the S&P 500's 33.7%. In the 2022 bear market (a long, deep market decline), IHF fell 12.3% and XHS 17.5%, less than the index's 24.5%. HEAL, the health technology fund, dropped 33.4%. HRTS, THNR and LGHT launched too late to have been tested by these downturns.
Healthcare services ETFs with the lowest expense ratios
| # | Fund | Expense ratio | On $10,000 | Net assets |
|---|---|---|---|---|
| 1 | XHS SPDR S&P Health Care Services ETF | 0.35% | $35 a year | $139.9M |
| 2 | IHF iShares U.S. Healthcare Providers ETF | 0.37% | $37 a year | $1.18B |
| 3 | HEAL Global X HealthTech ETF | 0.5% | $50 a year | $25.0M |
| 4 | HRTS Tema GLP-1 Obesity & Cardiometabolic ETF | 0.75% | $75 a year | $51.9M |
Ordinary funds with at least $10 million in net assets. The median ordinary healthcare services ETF charges 0.5% a year; leveraged and inverse funds usually charge more.
Do healthcare services ETFs pay dividends?
5 of the 6 ordinary healthcare services ETFs with a page here paid distributions over the last 12 months, with a median yield of 0.91%.
| Highest yields | Yield | Net assets |
|---|---|---|
| HRTS Tema GLP-1 Obesity & Cardiometabolic ETF | 1.25% | $51.9M |
| IHF iShares U.S. Healthcare Providers ETF | 0.91% | $1.18B |
| HEAL Global X HealthTech ETF | 0.23% | $25.0M |
| XHS SPDR S&P Health Care Services ETF | 0.15% | $139.9M |
Distributions over the last 12 months divided by the price; funds with at least $25 million in net assets.
How to choose a healthcare services ETF
- Fees range from 0.35% to 0.85%. XHS is the cheapest at 0.35%, with IHF close behind at 0.37%. HEAL charges 0.50%, THNR 0.59%, HRTS 0.75% and LGHT 0.85%. The fee comes out every year, whatever the fund returns.
- A few giants or many smaller companies. IHF puts 72% of its assets in its top 10 stocks and 21.9% in UnitedHealth Group. XHS holds the same number of stocks, 61, but its largest position is only 2.2%, so smaller companies count for more.
- What each fund counts as healthcare. IHF and XHS stay with U.S. providers and services. HEAL and LGHT lean toward health technology, while HRTS and THNR center on obesity treatments, with Eli Lilly and Novo Nordisk among their largest holdings.
- Index rules or a manager's picks. IHF, XHS, HEAL and THNR track published indexes, so their holdings follow set rules. HRTS and LGHT aim for long-term capital growth instead of matching an index, which gives the manager's choices more weight, for better or worse.
- U.S.-only or global holdings. IHF and XHS hold only U.S. stocks. HRTS and THNR own foreign drugmakers such as Novo Nordisk, and LGHT calls itself a global fund. Foreign stocks add currency swings on top of company results.
- Size and track record. IHF has about $1.18 billion and dates to 2006; XHS, about $140 million, to 2011. THNR, with about $4.4 million, and LGHT, about $2.5 million, both launched in 2024. Small funds are likelier to close.
What are the risks of healthcare services ETFs?
- One stock can steer IHF. IHF, which holds most of the group's money, has 72% of assets in its top 10 stocks, with UnitedHealth Group at 21.9% and CVS Health at 14.8%. Bad news at one or two companies can move the whole fund.
- Government payment and policy changes. Insurers and providers depend on government programs and rules. A change to payment rates, coverage or drug pricing can hit many holdings at once. That matters most for IHF and XHS, the funds focused on providers and services.
- Theme funds lean on two drugmakers. HRTS and THNR depend heavily on Eli Lilly and Novo Nordisk. Lilly is 11.5% of HRTS; Novo is 9.8% and Lilly 9.3% of THNR. A setback for either company could hit both funds hard.
- Large swings within a single year. As of May 16, 2025, one-year volatility, a measure of how much prices swing, ranged from 19.2% for XHS to 27% for HEAL. Worst drops over that year ran from 12.3% for XHS to 32.5% for THNR.
- Tiny funds with short histories. LGHT holds about $2.5 million and THNR about $4.4 million, and both launched in 2024. Very small ETFs can trade with wider price gaps and are more likely to close, returning cash that may be taxable.
List of all healthcare services ETFs, by size
| # | Fund | Net assets | Cost | Yield | YTD | 1 yr | 5 yr |
|---|---|---|---|---|---|---|---|
| 1 | IHF iShares U.S. Healthcare Providers ETF | $1.18B | 0.37% | 0.91% | +24.5% | +16.5% | +2.4% |
| 2 | XHS SPDR S&P Health Care Services ETF | $139.9M | 0.35% | 0.15% | +32.0% | +33.7% | +6.8% |
| 3 | HRTS Tema GLP-1 Obesity & Cardiometabolic ETF | $51.9M | 0.75% | 1.25% | +6.6% | +16.6% | — |
| 4 | HEAL Global X HealthTech ETF | $25.0M | 0.5% | 0.23% | +6.2% | -6.4% | — |
| 5 | THNR Amplify Weight Loss Drug & Treatment ETF | $4.4M | 0.59% | 1.67% | -2.4% | +8.1% | — |
| 6 | LGHT Langar Global HealthTech ETF | $2.5M | 0.85% | — | +11.3% | +4.3% | — |
Questions investors ask about healthcare services ETFs
What is the largest healthcare services ETF?
IHF, the iShares U.S. Healthcare Providers ETF, is the largest by a wide margin. It has about $1.18 billion in net assets out of roughly $1.40 billion across the six funds. Launched in 2006, it tracks an index of U.S. healthcare providers and is top-heavy: UnitedHealth Group is 21.9% of the fund and CVS Health 14.8%. The next largest, XHS, holds about $140 million.
What is the cheapest healthcare services ETF?
XHS, the SPDR S&P Health Care Services ETF, has the lowest expense ratio at 0.35% a year. IHF is close behind at 0.37%, followed by HEAL at 0.50%, THNR at 0.59% and HRTS at 0.75%. LGHT is the most expensive at 0.85%, and the median is 0.50%. Fees are only one difference, since XHS and IHF hold their stocks in very different proportions.
IHF vs XHS: what's the difference?
Both hold 61 U.S. healthcare provider and services stocks, 50 of them in common, but they size them very differently. IHF puts 72% of its assets in its top 10, with 21.9% in UnitedHealth Group. XHS spreads its money out, with about 20% in its top 10. Fees are similar at 0.37% for IHF and 0.35% for XHS. In the year to May 16, 2025, XHS gained 10.3% and IHF lost 9.7%.
Do healthcare services ETFs pay dividends?
Most do, but the payouts are small. Four of the six funds paid distributions, with a median yield of 0.86%. HRTS had the highest yield at 1.73%, followed by THNR at 1.01%, IHF at 0.86% and XHS at 0.32%. HEAL showed no yield, and LGHT is the other fund that does not pay. Income is a small part of what these funds offer.
Which healthcare ETFs hold UnitedHealth Group?
IHF and HRTS both hold UnitedHealth Group, but in very different amounts. It is IHF's largest holding at 21.9% of assets, so the stock's moves have a big effect on that fund. In HRTS, Tema's obesity and heart-health fund, UnitedHealth is about 5.2%, tied with Novo Nordisk behind Eli Lilly. Investors who already own UnitedHealth shares would add to that position through IHF.
How many healthcare services ETFs are there?
This group has six ETFs: IHF, XHS, HRTS, HEAL, THNR and LGHT. Together they held about $1.40 billion, and the five largest held 99.8% of it. IHF and XHS are the long-standing funds, launched in 2006 and 2011. HEAL followed in 2020, HRTS in 2023, and LGHT and THNR in 2024. None of the six uses leverage, inverse bets or options.
Are healthcare services ETFs defensive in a stock market crash?
Sometimes, but not reliably. In the 2022 bear market, IHF fell 12.3% and XHS 17.5%, less than the S&P 500's 24.5%. In the 2020 COVID crash, though, both fell further than the index: IHF lost 35.2% and XHS 39.3%, against 33.7%. In the 2008 financial crisis, IHF dropped 54.8%, about the same as the S&P 500's 55.2%. HEAL, a health technology fund, lost 33.4% in 2022.
Which healthcare ETFs hold Eli Lilly?
HRTS and THNR, the two funds built around obesity and weight-loss treatments, both hold Eli Lilly. It is HRTS's largest holding at 11.5% and makes up 9.3% of THNR, just behind Novo Nordisk at 9.8%. The two funds share 11 holdings worth 27.9% of assets. HRTS lost 16% in the year to May 16, 2025, the weakest one-year return in the group.
Is there a Vanguard, Fidelity or Schwab healthcare services ETF?
No. None of the three offers a healthcare services ETF. The largest healthcare services ETFs come from iShares (IHF), SPDR (State Street) (XHS) and Dawn Global Topco Ltd. (HRTS), and customers of all three firms can buy other companies’ ETFs in their brokerage accounts. For a broader fund, VHT (Vanguard Health Care ETF) and FHLC (Fidelity MSCI Health Care Index ETF) are covered in our healthcare ETF guide.
