Key Points
Fidelity MSCI Health Care Index ETF offers a significantly lower expense ratio of 0.08% compared to 0.4% for Invesco S&P 500 Equal Weight Health Care ETF.
Invesco S&P 500 Equal Weight Health Care ETF utilizes an equal-weight strategy across 60 stocks, while the Fidelity fund provides broad exposure to 365 companies.
Fidelity MSCI Health Care Index ETF has delivered higher 1-year total returns with a lower historical maximum drawdown.
Investors choosing between Fidelity MSCI Health Care Index ETF (NYSEMKT:FHLC) and Invesco S&P 500 Equal Weight Health Care ETF (NYSEMKT:RSPH) must weigh the lower cost and top-heavy concentration of FHLC against the broader equal-weighted approach of RSPH.
Both funds target the U.S. healthcare sector but use different construction methods. While FHLC provides broad exposure dominated by industry giants, RSPH levels the playing field by giving every S&P 500 healthcare constituent an equal seat at the table regardless of market size.
Snapshot (cost & size)
| Metric | RSPH | FHLC |
|---|---|---|
| Issuer | Invesco | Fidelity |
| Share price | $34.91 (as of 2026-07-30) | $79.44 (as of 2026-07-30) |
| Expense ratio | 0.4% | 0.08% |
| 1-yr return (as of 2026-07-30) | 21.5% | 26.4% |
| Dividend yield | 0.7% | 1.3% |
| Beta | 0.77 | 0.59 |
| AUM | $0.8 billion | $3.2 billion |
Beta measures price volatility relative to the S&P 500; beta is calculated from monthly returns over the available fund history (up to five years). The 1-yr return represents total return over the trailing 12 months. Dividend yield is the trailing-12-month distribution yield.
The Fidelity MSCI Health Care Index ETF is notably more affordable with its 0.08% expense ratio. It also offers a higher payout, with a yield gap of 0.63 percentage points over the Invesco fund.
Performance & risk comparison
| Metric | RSPH | FHLC |
|---|---|---|
| Max drawdown (5 yr) | (22.0%) | (17.7%) |
| Growth of $1,000 over 5 years (total return) | $1,172 | $1,290 |
What's inside
The Fidelity MSCI Health Care Index ETF (NYSEMKT:FHLC) provides broad exposure to the sector with 365 holdings, though it is market-cap weighted and therefore top-heavy. Its largest positions include Eli Lilly (NYSE:LLY) at 13.77%, Johnson + Johnson (NYSE:JNJ) at 9.06%, and AbbVie (NYSE:ABBV) at 6.60%. It was launched in 2013. The Fidelity fund has paid $1.02 per share over the trailing 12 months, which on its recent ~$79.44 share price works out to a 1.3% yield.
In contrast, the Invesco S&P 500 Equal Weight Health Care ETF (NYSEMKT:RSPH) tracks 60 holdings and assigns each an approximately equal weight, reducing the influence of mega-cap giants. Top holdings include Bio-Techne (NASDAQ:TECH) at 2.10%, IQVIA Holdings (NYSE:IQV) at 2.08%, and Veeva Systems (NYSE:VEEV) at 1.94%. It was launched in 2006. The Invesco fund has paid $0.23 per share over the trailing 12 months, which on its recent ~$34.91 share price works out to a 0.7% yield.
For more guidance on ETF investing, check out the full guide at this link.
What this means for investors
Few sectors are moving as fast as healthcare right now. GLP-1 drugs have reshaped metabolic medicine, biopharma deal activity hit its strongest quarter since 2020 earlier this year, and the FDA continues approving new treatments at a steady pace. For investors who want exposure to that momentum, FHLC and RSPH offer two structurally different paths through the same sector.
FHLC holds 365 healthcare companies weighted by market cap, meaning Eli Lilly, Johnson & Johnson, and AbbVie carry the most influence. That design lets the sector's biggest winners do the heavy lifting, and historically it has worked. RSPH holds just 60 S&P 500 healthcare stocks but weights each one equally, giving a smaller specialty company like Bio-Techne the same portfolio influence as Eli Lilly. That approach reduces concentration but has also delivered weaker long-term returns than FHLC's market-cap method.
RSPH also charges significantly more than FHLC. For most long-term investors, FHLC's lower cost, broader diversification, and stronger historical returns make it the more practical healthcare holding. RSPH appeals to those who specifically want to reduce dependence on a handful of megacap healthcare giants and are willing to pay more for that balance.
Sara Appino has no position in any of the stocks mentioned. The Motley Fool has positions in and recommends AbbVie, Eli Lilly, Iqvia Holdings, and Veeva Systems. The Motley Fool recommends Johnson & Johnson. The Motley Fool has a disclosure policy.