China's investments, financial incentives and deductions in terms of ecological conservation are based at the county level. Therefore, the monitoring and assessment of the effects of ecological conservation at the county level is important to provide a scientific basis for the assessment of the ecological and environmental quality at the county scale. This paper quantitatively estimated the dynamics of high-quality ecosystems and vegetation coverage over the past 15 years, and their relationships with the number of ecological conservation programs at the county level were analyzed. Then, the effects of ecological conservation measures on ecological changes at the county level and their regional suitability were assessed and discussed. The results showed that counties with a percentage of high-quality ecosystems greater than 50% were primarily distributed in northeastern China, southern subtropical China and the southeastern Qinghai-Tibet Plateau, and those with a percentage lower than 20% were mostly distributed in northwestern China, the southwestern karst region and the North China Plain. In recent decades, ecological conservation has focused on ecologically fragile regions; more than five ecological conservation programs have been implemented in most counties of the Three River Source Region in Qinghai Province, southeastern Tibet, western Sichuan, the Qilian Mountains, southern Xinjiang and other western regions, while only one or zero have been implemented in the eastern coastal area of China. Over the past 15 years, the proportional area of high-quality ecosystems has increased in approximately 53% of counties. The vegetation coverage of counties in the Loess Plateau, Huang-Huai-Hai Plain, Beijing-Tianjin-Hebei (Jing-Jin-Ji), Sichuan-Guizhou-Chongqing, and Guangdong-Guangxi provincial-level areas has increased significantly. However, it decreased in northern Xinjiang, central Tibet, central and eastern Inner Mongolia, the Yangtze River Delta and other regions. The relationships between the numbers of ecological conservation programs and the indicators of ecosystem restoration response, such as high-quality ecosystem and vegetation coverage, do not show positive correlations. These results suggest that ecological conservation programs should be planned and implemented according to the distribution patterns of high-quality ecosystems and that restoration measures such as afforestation should follow natural principles and regional differentiation under the background of climate change. [ABSTRACT FROM AUTHOR]