The aim of this study is to dissect and enhance the tripartite collaborative governance mechanisms among polluting enterprises, the public, and government regulatory bodies within the scope of China’s recent healthcare reforms. Through the lens of an evolutionary game model, this research seeks to understand the strategic evolutionary equilibrium among these actors and evaluate the impact of various incentives and penalties on their decision-making processes. Utilizing an evolutionary game model from a bounded rationality perspective, it investigates the strategic evolutionary equilibrium among the stakeholders and the influence of various factors on their strategic evolution. A critical equilibrium point E5(1,1,0) was identified, where enterprises adopt clean production strategies, the public engages in environmental governance, and the government exercises lenient regulatory strategies. Empirical analysis employing real-world data further substantiates the theoretical findings, showcasing how governmental bodies can drive clean production measures among polluting enterprises through economic incentives or penalties. The study outlines pivotal measures for achieving collaborative ecological governance in the Pearl River Delta region, such as establishing an information sharing platform, augmenting government regulation and enforcement, encouraging clean production in enterprises, enhancing public participation, and bolstering support for technological innovation. These measures could promote continuous environmental amelioration and sustainable development in the region. The findings offer both theoretical and practical insights for multifaceted environmental governance in China, illuminating the nuanced interplay among governmental bodies, industries, and the public in enhancing environmental standards and healthcare reforms.