[Objective]Simulating the impacts of land use change on ecosystem health under different scenarios, and deeply exploring the synergistic mechanism of land use change and ecosystem health are of great significance for optimizing land use pattern and sustainable development. [Methods] This paper clarifies the ecosystem health evolution pattern of Qinghai Province from 2005 to 2020 based on the VORS and GMMOP-PLUS models, and simulates the extent of the impacts of land use changes on ecosystem health under four development scenarios. [Results] (1) The mean value of ecosystem health in Qinghai Province decreased from 0.292 to 0.252 during 2005-2020, with poor and worse distribution in the Qaidam Basin and peripheral municipalities and counties, generally concentrated around the Qinghai-South Plateau and Huanghe Valley, and with better and better areas of ecosystem health mainly distributed in the Qilian Mountains area, the Animacine Mountains, and the Lancang River Basin. (2) Based on the GMMOP-PLUS model and by setting different natural and social policy conditions, the land use change characteristics of the four development scenarios (natural development ND, ecological protection EP, urban development UD and comprehensive development CD) in 2030 were simulated, and the construction land has been increased to varying degrees, among which the increase of construction land in the UD and CD scenarios is 37,200 hm2, which is mostly converted from cultivated land and grassland. Ecological land is effectively protected in the EP scenario, with forest land and wetland accounting for the largest proportion of 7.54%. (3) The size of the ecosystem health index under different scenarios is: EP(0.256) > CD (0.253) >ND (0.252) > UD (0.250). Except for the nature scenario, the ecosystem services of the other three scenarios were significantly enhanced, and the enhancement areas were concentrated in the Qaidam Basin, Golmud City and Zhiduo County.[Conclusion] The vegetation cover level and ecosystem health index of the Qaidam Basin and the western part of the Qinghai-Nanjing Plateau will increase from 2005 to 2020, but the ecosystem health of the Huangshang Valley, the Qilian Mountain area and the river system in the eastern part of the Plateau will slightly decrease due to the degradation of vegetation brought about by human activities. According to the simulation of land use changes under different scenarios, the key to improving the ecosystem health index lies in controlling the development speed and boundaries of arable land and construction land, spatially intensifying the use of land, and promoting the transformation of unutilized land into ecological land.