A complex relationship exists between natural environmental and urban systems. This study focuses on the province of Qinghai, which is a major part of the Tibetan Plateau. For the period 1995–2020, we explore the relationships between ecosystem health and urbanization. We established an indicator system for ecosystem health and urbanization and quantitatively analyzed the spatiotemporal pattern of coupling coordination between the two. It shows that between 1995 and 2020, the urbanization level in Qinghai showed a continuous upward trend, with the urbanization index in 2020 increasing by 147.20% compared to 1995. The level of ecosystem health also showed an upward trend, with the ecosystem health index (EHI) value in 2020 increasing by 3.31% compared to 1995. The coupling coordination degree between ecosystem health and urbanization in Qinghai increased year-on-year. Areas with high coupling coordination between ecosystem health and urbanization basically overlapped with areas with high urbanization, and the area gradually increased during the study period. Locations with slightly unbalanced development were located on the periphery of high coupling-coordination areas, and that area expanded in the years covered in this study. The low coupling-coordination areas were located in the northwest and southwest of Qinghai, bounded by the Qinghai-Tibet Highway. These results can support the evaluation of ecosystem health and urbanization on the Tibetan Plateau and high-altitude river source areas similar to Qinghai in China and elsewhere, contributing to sustainable land use policy.