Abstract: The decentralisation of high-quality healthcare resources, a core initiative of the Healthy China strategy, faces practical challenges, including the inverted pyramid distribution of resources, obstructed coordination mechanisms, and entrenched patient preferences for healthcare choices. The present study examines the paradigm shift from "unidirectional decentralisation" to "multi-stakeholder win-win" in this process. The construction of a four-party evolutionary game model enables the depiction of the strategic interactions among the government, tertiary hospitals, primary healthcare institutions, and patients under the framework of bounded rationality. This study also explores the conditions for collaboration and the underlying mechanisms that facilitate it. The equilibrium states and critical threshold conditions of system evolution are identified through the replication of dynamic equations and stability analysis. Multi-scenario simulations and parameter sensitivity tests have been used to reveal the system's evolutionary patterns and effective pathways for policy intervention. The findings indicate the following: Firstly, government regulatory costs, fiscal compensation, and stakeholder participation willingness have been shown to significantly influence evolutionary trajectories and convergence rates, revealing an 'incentive duality paradox'. Secondly, enhanced participation willingness among tertiary hospitals has been demonstrated to generate an 'incentive substitution effect'. Thirdly, patient behaviour exhibits rigid characteristics, significantly constraining the lack of trust in primary care. In order to resolve these coordination dilemmas and enhance the effectiveness of resource decentralisation, systematic policy recommendations will be proposed across four dimensions: dynamic incentive design, optimisation of the government's role, restructuring of fiscal mechanisms, and cultivation of trust capital. This provides theoretical foundations and decision support for promoting the efficient decentralisation of high-quality healthcare resources and establishing a multi-stakeholder win-win framework.