Yahoo Finance analysis indicates that the State Street Health Care Select Sector SPDR ETF (XLV), focusing on U.S. healthcare leaders, has outperformed the iShares Global Healthcare ETF (IXJ) in both one- and five-year total returns. XLV also boasts a significantly lower expense ratio of 0.08% compared to IXJ's 0.38%. While IXJ offers broader global diversification with 110 stocks (approximately 70% U.S.-based), XLV maintains a more concentrated portfolio of 60 U.S. stocks, with its top three holdings (Eli Lilly, Johnson & Johnson, and AbbVie) making up about 33% of its portfolio, compared to 22% for IXJ.