Led by biotechnology exchange traded funds, 2014 has been another year to remember for health care ETFs. The sector is the S&P 500’s top performer and the Health Care Select Sector SPDR (NYSEArca: XLV) entered Wednesday with an advantage of nearly 200 basis points over the Utilities Select Sector SPDR (NYSEArca: XLU) for top honors among the nine sector SPDR ETFs.

Bullishness for the health care sector has not been confined to the U.S. International health care stocks and global ETFs tracking the sector have been getting in on the fun as well. The iShares Global Healthcare ETF (NYSEArca: IXJ) is up 5.6% in the past month and touched an all-time high Wednesday.

There is an important difference between ETFs that carry the “global” label and those that are true international funds. That difference is to be remembered with IXJ because global allows for the inclusion of U.S. stocks, which in the case of IXJ has been a positive. [Health Care Heaven With ETFs]

The U.S. accounts for over 64% of IXJ’s country weight and five U.S. companies are found among the ETF’s top-10 holdings. Again, that is a positive, particularly when considering that two of those names are Johnson (NYSE: JNJ) and Merck (NYSE: MRK), two of the best performers this year in the Dow Jones Industrial Average. Two of the other U.S. names in IXJ’s top-10 lineup are Amgen (NasdaqGS: AMGN) and Gilead Sciences (NasdaqGS: GILD) which are up 44% and 33.1%, respectively this year. [A Look at the Dominance of Health Care ETFs]

The only other double-digit country allocation found in IXJ is a 12% weight to Switzerland, which is arguably a double-edged sword. There is some currency risk as highlighted by the 7.5% year-to-date decline by the CurrencyShares Swiss Franc Trust (NYSEArca: FXF). On a more positive note, due in part to the market’s heavy bias towards health care stocks, Switzerland is one of Europe’s most dependable dividend growth markets, explaining why it often commands valuation premiums relative to higher beta Eurozone nations.