High-quality development is the theme of China’s economic and social development in the new era, the only way to build a powerful tourism economy, and also the objective demand to solve the practical problems and promote the transformation and upgrading of tourism. However, problems such as inefficient operation, environmental pollution, and slow industrial upgrading have become prominent in the development process of China’s tourism industry in recent years, in which a gap exists with the realization of high-quality development goals. Therefore, scientific control of the gap and deviation between the actual development level and the high-quality development goals of tourism is helpful for promoting the green and sustainable development of regional tourism. This study, taking the Taihu Lake Basin as an example, made a systematic and comprehensive evaluation of the spatial-temporal pattern of high-quality development mismatch of tourism from 2010 to 2019, using the health distance model to analyze its spatiotemporal evolution characteristics, and combining the obstacle degree model and qualitative comparative analysis of fuzzy set to analyze its influencing mechanism. The empirical results show that: (1) the mismatch degree of high-quality development of tourism in the Taihu Lake Basin shows a downward trend, and the regional imbalance is prominent, showing polarization characteristics; (2) among the six systems, only the green system and the cultural and tourism resource system are in the matching type, the dominant system of mismatch type is different in each city, and it shows the characteristics of the transformation from external environmental obstacle to internal environmental obstacle in the process of transition from mismatch type to matching type; (3) the spatiotemporal pattern of high-quality development mismatch of tourism is the result of six systems working together, in which the innovative development system is the core driving force, the coordinated development system is the potential driving force, the green development system is the direct driving force, the open development system has the guiding function, the shared development system is the external driving force, and the literature and tourism resource system is the basic driving force. Therefore, the paper puts forward three types of combination paths and corresponding suggestions that can promote the transformation and upgrading of tourism and achieve coordinated development of the Taihu Lake Basin.