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Water resources play a vital role in the process of economic development, especially in arid and semi-arid regions. Improving the efficiency of water use is an effective way to solve the shortage of water resources. In this paper, influencing factors of water utilization efficiency in three inland river basins (Shiyang, Heihe, and Shule river) in Gansu Province, Northwest China, are investigated. Using survey data of 306 households, results of the multiple linear regression analysis show that management capacity and its strictness in a different basin, irrigation technology and facility conditions, and farmers’ self-government are key factors affecting farmers’ irrigation efficiency. Additionally, factors at the farmer and family level, as well as the differences in natural conditions and economic and social development in different regions, also have a significant impact on water use efficiency.