At a glance
RSPH charges 0.4% a year, above the 0.38% average of the 8 funds most like it (the 5th cheapest of 9). It has $766.9M in assets, the 7th largest of that group; it paid 0.56% of its price in distributions over the past 12 months, quarterly. Over the past year it returned +28.4% with distributions reinvested (S&P 500: +11.5%), 3rd of those 9 funds; over three years it returned +16.6% a year. Its ten largest positions make up 19.4% of the fund, out of 60 in all.
The short version
Invesco S&P 500 Equal Weight Health Care ETF (RSPH) holds every health care company in the S&P 500, about 60 stocks, and gives each one the same weight instead of weighting by size. As a result, smaller companies such as Bio-Techne and DaVita count about as much as Thermo Fisher or Abbott. The trade-off is cost. Its 0.40% expense ratio compares with 0.08% for the Health Care Select Sector SPDR Fund (XLV) and 0.09% for Vanguard Health Care ETF (VHT).
Price history
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RSPH +28.4% over the year to Oct 27, 2026, total return with distributions reinvested.
How it has behaved
| YTD | 1 yr | 3 yr | 5 yr | 10 yr | Since start | |
|---|---|---|---|---|---|---|
| RSPH official prospectus, to Dec 31, 2025 | — | +9.34% | — | +4.72% | +8.22% | — |
| RSPH price data to Oct 27, 2026 | +24.2% | +28.4% | +16.6% | — | — | +10.7% |
- Over the year to Oct 27, 2026, RSPH returned +28.4%, 3rd of 9 among similar funds.
- Its worst full calendar year was 2024 (-0.9%); its best was 2025 (+9.6%).
- The deepest fall in its price history was 17.1% (Sep 19, 2024 to Apr 21, 2025), recovered by Nov 25, 2025.
Show as a table
| Year | Price data | Prospectus (official) |
|---|---|---|
| 2026 (to date) | +24.2% | — |
| 2025 | +9.6% | +9.34% |
| 2024 | -0.9% | -0.80% |
| 2023 | — | +3.94% |
| 2022 | — | -9.24% |
| 2021 | — | +23.03% |
| 2020 | — | +18.91% |
| 2019 | — | +25.34% |
| 2018 | — | -0.32% |
| 2017 | — | +23.40% |
| 2016 | — | -4.50% |
| 2008 financial crisis stocks fell Oct 9, 2007 – Mar 9, 2009 | Not in the price data, which starts Jun 7, 2023 |
|---|---|
| 2020 COVID crash stocks fell Feb 19, 2020 – Mar 23, 2020 | Not in the price data, which starts Jun 7, 2023 |
| 2022 bear market stocks fell Jan 3, 2022 – Oct 12, 2022 | Not in the price data, which starts Jun 7, 2023 |
Dividends and income
Show as a table
| Year | Per share | Change |
|---|---|---|
| 2026 (to date) | $0.1700 | |
| 2025 | $0.2300 | +9.5% |
| 2024 | $0.2100 |
What's inside
As of Jul 31, 2026, the fund held 60 securities; the ten largest made up 19.44% of assets, and 2.3% sat in cash and money-market holdings.
| Holding | Weight | |
|---|---|---|
| Bio-Techne Corp. | 2.13% | |
| IQVIA Holdings Inc. | 2.00% | |
| Baxter International Inc. | 1.99% | |
| Regeneron Pharmaceuticals, Inc. | 1.96% | |
| Mettler-Toledo International Inc. | 1.94% | |
| Charles River Laboratories International, Inc. | 1.93% | |
| Veeva Systems Inc. | 1.93% | |
| DaVita Inc. | 1.87% | |
| Moderna, Inc. | 1.85% | |
| Thermo Fisher Scientific Inc. | 1.84% | |
| Abbott Laboratories | 1.83% | |
| Bristol-Myers Squibb Co. | 1.82% | |
| Universal Health Services, Inc. | 1.80% | |
| Labcorp Holdings Inc. | 1.78% | |
| Quest Diagnostics Inc. | 1.77% |
By country
United States 96.55%Ireland 3.35%By asset type
Stocks 99.9%By sector
Sectors of the companies held, for the 60% of the fund in companies that have a stock page here; other holdings and cash aren't classified. Source: N-PORT holdings report as of Jul 31, 2026. Cash, money-market funds and derivatives are shown separately from the securities list.What changed recently
- Over the three months to Jul 31, 2026, investors withdrew a net $12.1M (creations minus redemptions, per the N-PORT report).
- Monthly total returns reported for that quarter: +2.30%, +6.61%, +4.86%.
How it works
RSPH tracks the S&P 500 Equal Weight Health Care Index, which S&P Dow Jones Indices compiles and maintains. The index includes every S&P 500 company that the Global Industry Classification Standard (GICS, a system that sorts companies into sectors) places in health care. That covers health care providers and services, equipment and supplies makers, health care technology firms, and drug and biotech companies. As of June 30, 2026, the index had 59 members, worth between $7.9 billion and $1.1 trillion each.
Most sector funds give the biggest companies the most weight. This index resets every company to the same weight at each quarterly rebalance. Between rebalances, weights drift as prices move. As of July 31, 2026, the largest position was Bio-Techne at 2.1%, and the top 10 made up 19.4% of assets. Rebalancing means trimming stocks that have risen and adding to ones that have fallen. Portfolio turnover was 24%.
The fund uses full replication, meaning it generally owns every stock in the index in the index's proportions. It must keep at least 80% of net assets in index stocks or similar investments. It held no derivatives as of July 31, 2026. Because it follows the index, it won't sell a lagging stock unless the index drops it. Equal weighting also gives more weight to mid-sized companies, which can be more volatile than the largest ones.
What it really costs
- RSPH charges 0.4% a year, versus an average of 0.38% for the similar funds below (5th of 9, cheapest first).
- Using the prospectus's standard example, $10,000 invested would cost about $41 in the first year and $505 over 10 years (assuming a 5% annual return).
| Cost of $10,000 (SEC example) | 1 yr | 3 yrs | 5 yrs | 10 yrs |
|---|---|---|---|---|
| RSPH | $41 | $128 | $224 | $505 |
In a retirement portfolio
It is a single-sector fund that tilts toward smaller health care companies, so it fits better as a small add-on than as a main holding.
The prospectus has no figures for 2008. In 2020 the fund fell 14.3% in the first quarter but finished the year up 18.91%. It lost 9.24% in 2022, its worst calendar year from 2016 through 2025. In the price history that starts in June 2023, its deepest drop was 17.1%, from September 19, 2024 to April 21, 2025. It took about seven months, until November 25, 2025, to get back to its old high. A retiree who sold shares near that low would have locked in the loss. The yield was 0.56% as of October 27, 2026, paid quarterly, so it adds little income. In the SEC's standard example, $10,000 invested costs $41 in fees in the first year and $505 over 10 years. Past results don't predict the future, and a plan should look at the whole portfolio, not one fund.
Who it may suit — and who should look elsewhere
May suit
- Investors who want health care exposure without the biggest drugmakers dominating; no single stock was above about 2.1% as of July 31, 2026.
- Holders of a broad S&P 500 fund who want a health care tilt toward mid-sized companies such as DaVita, Bio-Techne and Charles River Laboratories.
- Long-term holders comfortable with quarterly rebalancing that trims winners and adds to laggards, with 24% portfolio turnover.
Look elsewhere if
- Cost-focused investors: XLV charges 0.08% and VHT 0.09% a year, compared with 0.40% here.
- Anyone seeking income: the trailing 12-month yield was 0.56% as of October 27, 2026.
- Investors uneasy with single-sector risks such as government drug-pricing and reimbursement pressure; the fund lost 9.24% in 2022.
Close alternatives
Matched by holdings overlap from the latest N-PORT reports.
| Fund | Overlap | Cost | Net assets | 1 yr | 3 yr |
|---|---|---|---|---|---|
| RSPH this fund | — | 0.4% | $766.9M | +28.4% | +16.6% |
| XLV Health Care Select Sector SPDR Fund | 52% | 0.08% | $40.60B | +30.2% | +16.2% |
| FXH First Trust Health Care AlphaDEX Fund | 51% | 0.6% | $1.05B | +19.7% | +15.1% |
| VHT Vanguard Health Care ETF | 49% | 0.09% | $22.04B | +28.9% | +16.9% |
| FHLC Fidelity MSCI Health Care Index ETF | 49% | 0.084% | $3.29B | +23.8% | +16.0% |
| IYH iShares U.S. Healthcare ETF | 46% | 0.39% | $3.56B | +23.8% | +15.0% |
| IXJ iShares Global Healthcare ETF | 45% | 0.41% | $3.84B | +19.5% | +13.4% |
| MDEV First Trust Indxx Medical Devices ETF | 38% | 0.7% | $1.9M | +4.2% | +10.3% |
Questions investors ask
How has RSPH performed over the long term?
RSPH returned an average of 8.22% a year over the 10 years through December 31, 2025, and 4.72% a year over five years, according to its prospectus. Results varied widely from year to year, from a 25.34% gain in 2019 to a 9.24% loss in 2022. On a price basis, it returned 28.4% over the year through October 27, 2026, and 16.6% a year over three years.
What's the difference between RSPH and XLV?
Both funds hold S&P 500 health care stocks, and about 52% of their holdings overlap. RSPH resets every company to the same weight each quarter, so smaller firms count as much as giants. XLV costs 0.08% a year, compared with 0.40% for RSPH, and it is much larger: $40.6 billion as of June 30, 2026, against $767 million for RSPH as of July 31, 2026. Their three-year annual returns were close, at 16.2% for XLV and 16.6% for RSPH.
Does RSPH pay dividends?
Yes. RSPH pays dividends every quarter, but the amounts are small. Over the 12 months through October 27, 2026, it paid $0.22 per share, a yield of 0.56%. Many health care companies pay little or no dividend because they put their cash back into research and growth. Investors who need steady income from their portfolio would get very little of it from this fund.
What is RSPH's expense ratio?
RSPH's expense ratio is 0.40% a year, which is all management fee, according to its prospectus filed August 27, 2026. In the SEC's standard example, $10,000 invested at a 5% annual return would cost $41 in the first year, $224 over five years and $505 over 10 years. That is close to the 0.38% average for similar health care funds, but several large rivals charge less than 0.10%.
What are RSPH's top holdings?
As of July 31, 2026, RSPH's largest holdings were Bio-Techne at 2.1%, followed by IQVIA, Baxter International and Regeneron Pharmaceuticals at about 2.0% each, then Mettler-Toledo at 1.9%. The fund held 60 stocks, and the top 10 made up just 19.4% of assets because of equal weighting. About 96.6% of assets were in US companies and 3.4% in companies based in Ireland.