By most measures, Italy is one of the healthiest countries in the world. But there is less agreement about how -- and even whether -- the country's health care system can be improved.

Debate about health care bubbles up periodically in Italy, and the most recent discussion came after Italy slipped a spot to the second, just behind Spain, on the Bloomberg Healthiest Country Index. The index ranks the countries on an array of criteria such as environmental health, life expectancy and behavioral patterns gathered from the World Health Organization, the World Bank and the United Nations Population Division.

The index echoes other global measures of national health, like those from pharmaceutical industry groups, the Legatum Prosperity Index, or UN life expectancy data.

A drop from the first to the second is a minimal change,but the country's world class health outcomes has been a subject of national pride. As a result, the small slide from the top spot was news across the country.

"A difference of one spot is not anything we should be concerned about," Alessandro Solopaca, scientific director of the national health observatory for Italian regions, told Xinhua. "Such a small change could be due to the way statistics are calculated. The change is mostly symbolic."

But some of Italian media reports have speculated on what Italy would have to do to regain the top spot when the next ranking is calculated.

Falling health care spending could be a factor, according to analysts. Italy's health care system in its current form was founded in 1978, with the goal of providing equal coverage to all citizens regardless of means.

After reaching a peak in the early 2000s, spending has generally decreased as a percentage of the country's gross domestic product. According to European Union figures, last year Italy spent around 7.1 percent of the country's gross domestic product on health care, about equal to the European Union average. A decade ago, the country had one of the highest rates in the European Union using the same measure.

Additionally, the amount of all health care spending paid for privately -- whether through private insurance or by the individual -- is on the rise.

"The biggest thing we can do to improve the system would be to invest more money, in order to update medical technologies and infrastructure and to hire more staff," Solopaca said.

Marco Alfonsi, a health care researcher at the University of Milan, agreed, writing in a white paper that, "Italian medical personnel achieve admirable results, but they are continually being asked to do more with less."

The reasons behind Italy's positive health outcomes are a matter for debate. There is no doubt that free and universal health care plays a big role. But so do the famed "Mediterranean diet," good weather all year, and possibly even genetics.

"Strong health outcomes are a combination of many factors, and it is impossible to measure the value of each," Solopaca said. "But I think the biggest one is having health care available to every citizen."

Not everyone agrees the health care system can be improved. Alberto Fidanza, author of multiple books and articles on the "Mediterranean diet" and a professor of physiology and nutrition science at the University of Rome, said the system provides optimal results as it is.

"Nothing has to change with our health system," Fidanza told Xinhua. "It cannot be improved."

Solopaca, Alfonsi and others disagreed. Solopaca said that even without more money, outcomes could be improved through education initiatives promoting better personal habits, such as the value of exercise and risks associated with certain foods.

"There are things we could do differently that would involve very little spending," Solopaca said. "That can start with educating the public about what they can do individually."