In this paper, we analyze the performance of the state-of-the-art end-to-end security schemes in healthcare Internet of Things (IoT) systems. We identify that the essential requirements of robust security solutions for healthcare IoT systems comprise of (i) low-latency secure key generation approach using patients’ Electrocardiogram (ECG) signals, (ii) secure and efficient authentication and authorization for healthcare IoT devices based on the certificate-based datagram Transport Layer Security (DTLS), and (iii) robust and secure mobility-enabled end-to-end communication based on DTLS session resumption. The performance of the state-of-the-art security solutions including our end-to-end security scheme is tested by developing a prototype healthcare IoT system. The prototype is built of a Pandaboard, a TI SmartRF06 board and WiSMotes. The Pandaboard along with the CC2538 module acts as a smart gateway and the WisMotes act as medical sensor nodes. Based on the analysis, we found out that our solution has the most extensive set of performance features in comparison to related approaches found in the literature. The performance evaluation results show that compared to the existing approaches, the cryptographic key generation approach proposed in our end-to-end security scheme is on average 1.8 times faster than existing key generation approaches while being more energy-efficient. In addition, the scheme reduces the communication overhead by 26% and the communication latency between smart gateways and end users by 16%. Our scheme is also approximately 97% faster than certificate based and 10% faster that symmetric key-based DTLS. Certificate based DTLS requires about 2.9 times more ROM and 2.2 times more RAM resources. On the other hand, the ROM and RAM requirements of our scheme are almost as low as in symmetric key-based DTLS.