Water use efficiency (WUE) measures the trade-off between carbon gain and water loss of terrestrial ecosystems, and better understanding its dynamics and controlling factors is essential for predicting ecosystem responses to climate change. We assessed the magnitude, spatial patterns, and trends of WUE of China's terrestrial ecosystems and its responses to drought using a process-based ecosystem model. During the period from 2000 to 2011, the national average annual WUE (net primary productivity (NPP)/evapotranspiration (ET)) of China was 0.79 g C kg(-1) H2O. Annual WUE decreased in the southern regions because of the decrease in NPP and the increase in ET and increased in most northern regions mainly because of the increase in NPP. Droughts usually increased annual WUE in Northeast China and central Inner Mongolia but decreased annual WUE in central China. "Turning-points" were observed for southern China where moderate and extreme droughts reduced annual WUE and severe drought slightly increased annual WUE. The cumulative lagged effect of drought on monthly WUE varied by region. Our findings have implications for ecosystem management and climate policy making. WUE is expected to continue to change under future climate change particularly as drought is projected to increase in both frequency and severity.