'I like efficiency," said Madonna, explaining why she chose to have her second baby in the United States last August rather than in the UK, where she said the hospitals were "old and Victorian". For most families, anywhere in the world, their most intimate experience with a healthcare system is having a baby.
The US has an excellent healthcare system for those who can afford complex and costly private insurance - Madonna could, of course, afford to give birth at Cedars-Sinai, in Los Angeles, one of the world's best hospitals - or who fit into a web of public programmes. Insured mothers are taken through childbirth by obstetricians rather than midwives, and they receive thorough, efficient care.
Sharon Dillon, a doctor from Dublin, had her first child, Cliona, in Dublin three years ago and her second, Ciara, in New York in June, under the company insurance of her husband, Barry.
"Certainly, in America they have wonderful baby units for neo-natal," she said. "I got really superb care. But in my first pregnancy, I got really superb care in Holles Street, and Ireland has a very high standard of specialists.
"In my experience, once you are a private patient in the US, you have very little access to public health. In Ireland, every private patient has access to public health. I had a community nurse who came to the house, whereas in New York you would have to pay something like $100 a visit.
"Once you leave the hospital, Ireland has a really good community care system, but in the American system you have to pay up for everything.
"The Irish system provides care for infants of every socio-economic group, it provides screening for every child in the country, whereas in America that's not really available, in that you go to your paediatrician for that sort of care; it's very much up to you to bring your child to the paediatrician. In Ireland, you have the public-health nurse knocking on your door. They will come and weigh your baby in your home if you can't make it to a clinic. They are like your mother, really. Certainly, I missed that an awful lot in America.
"On the ground, the Irish system, when it came to mothers and babies, is so much better. If I had had my baby in Holles Street, I could call up any time, day or night, and say I'm worried about my baby, and I could bring it into the hospital, and they would be more than willing to look at it. In America, you have to be insured, and hospital costs could really hit you hard economically."
Despite full insurance, says Barry Dillon, they had to pay $400 for a private room with a broken lounger, missing skirting boards and defective bed guards, which meant the baby could fall out. "The room was not kept clean and the nurses ignored Sharon's request that they not give Ciara bottles, as she was trying to breastfeed," he says. The Dillons were also billed $700 for work by a doctor they never met and were threatened with a collection agency before establishing it was a "mistake".
The culture of nursing also makes a big difference. Dillon found nursing standards much higher in the Republic than in the US.
"The nursing people in the US are way behind the Irish. Irish nurses are very nurturing, very emotionally involved with the babies. It's much more of a vocation for them.
"Anyone who has had a baby here and in America knows the Irish nurses are so much more superior. Technically and charismatically, they are with you, they have the skills and knowledge and they are emotionally on the same level. They have confidence in their knowledge."
While nurses in the US are often highly specialised and trained, many hospitals employ less trained practical nurses or nurse aides to undertake patient care at lower cost.
Marie Hewitt, a Belfast-trained nurse who works in a Washington DC hospital, says: "In the US there is a lot more surface emotional connection, but in Britain and Ireland there is a greater commitment to human beings. American nurses know all the psychological buzzwords without the depth of dedication. Irish nurses probably have a lot more empathy with less words."
She found that socially deprived mothers can rarely afford proper post-natal care; employers tend not to have maternity leave - some allow "disability" leave - and there are no European-style baby allowances. "The nurses in an Irish hospital are with you right through your pain," says Dillon. "When it comes to New York, it's not there for you. It's almost like the social structure doesn't reward people like that. I found it a bit of a shock."